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THE TEACHING OF SURGICAL ANATOMY.
820
ANATOMY.
THE TEACHING OF SURGICAL As advance in medicine takes place we see new an intricate methods of diagnosis devised, the chemica changes underlying many diseases revealed, th resources of physical science called upon for treat ment, the horizon of bacteriological and immunologica science ever enlarging. No perfunctory method o study will now serve to equip the medical student fo He must go through his future work in life. Th. strenuous, exacting, and prolonged course. curriculum becomes more and more crowded as the specialists in the different branches of medicine clain to have each his own subject embodied in it. This process of inclusion must inevitably reach a limi beyond which it is inadvisable to go, for it is necessary to train practitioners who, as the subdivision o medical knowledge proceeds, preserve a broac outlook, free from all trace of those obsessions whicl beset the enthusiastic worker in a limited field Indeed, it is questionable whether it would not b( in the interests of the public and their doctors ii some curtailment of the medical curriculum wert not to be enforced even now. This applies almost a much to the basic sciences of anatomy and physiology as to the more recent growths of biochemistry and radiography. Anatomical knowledge is indeed necessary for diagnosis and for the surgical operator, but it may well be asked by the reader of such a book as that by Prof. DEAVER1 on " Surgical Anatomy of the Human Body " whether already too much is expected of the student. Here is a treatise on anatomy written by a surgeon with the surgeon’s needs in view. It is beautifully illustrated ; the pictures are realistic in the impressions they give. Everything the surgeon could conceivably desire to know, every relation which could possibly be of importance to him is described and figured. It is an exhaustive treatise on surgical anatomy, it is wellnigh perfect of its kind-but it is a book of 2168 pages in three large volumes. Should a student during the clinical years be expected to read such a large volume ? Should it be necessary, after two years’ study in the dissection room, for him to read it ? Now that the teaching of anatomy in the earlier years is in the hands of specialists it is essential for instruction in so-called surgical anatomy to be continued later, for until the student has some clinical knowledge he cannot get a grasp of surgical problems. But when it comes to arranging the scope of such a course, difficulties arise. For the future surgeon an accurate and deep knowledge of anatomy is essential. Most inaccessible structures are
apt suddenly
to
assume
surgical importance
as
the understanding of disease becomes more exact. The development of pituitary surgery, the introduction of splanchnic anaesthesia, illustrate how the most abstruse anatomical relations enter into practical everyday operating. But for the future general practitioner too extensive a course of surgical anatomy may deprive him of clinical opportunities which will not recur. It might be a wise policy for instruction in surgical anatomy to be restricted so as to comprise only that which is helpful in the diagnosis of disease or necessary for the performance of the common operations and especially those urgent procedures which every doctor may be called upon to carry out. Those on whom it falls to devise medical curricula should insist upon the instillation of principles, upon 1 Surgical Anatomy of the Human Body. Second edition. By John B. Deaver, M.D., Sc.D., LL.D., F.A.C.S., Surgeon in Chief to the Lakenau Hospital, Philadelphia; Emeritus John Red Barton, Professor of Surgery, University of Pennsylvania. London: William Heinemann. 1927. Vol. i., pp.551; vol.ii., PP. 854 ; vol. iii., pp. 763. 8 guineas the set.
broad generalisations, and a wide outlook. Detailed information can always be obtained from books; for this purpose the only essential is for the worker to know of the existence of such knowledge and where it can be obtained. If the newly qualified practitioner has absorbed the basic principles of his art, if advanced demonstrations have opened up for him a vista of the refinements of science without clogging his perception with needless detail, if, in fact, he approaches his work with the right mental attitude and equipment, defects in special knowledge will not handicap him in his dealings with his patients. They can be remedied easily by reference to trustworthy sources of information.
A CRITIC OF THE JURY SYSTEM. AT the latest of the provincial meetings of the Law Society, held at Sheffield recently, a member read a paper on The Jury System : Its Cause and Cure, in which he criticised as unsuitable and unsatisfactory the present system under which it is left to juries to assess damages upon allegations of negligence in the certification of lunatics. The critic proposed to substitute trial of such cases in camera before a special tribunal consisting of a medical practitioner, a solicitor, two trained professional jurymen, and (as chairman) a barrister or judge. Evidently some of the recent decisions of juries at the expense of certifying doctors have awakened surprise and misgiving outside the ranks of the medical profession. The trained professional jurymen whom the speaker at Sheffield had in mind were to be a new type. They were to be persons who had had 15 years’ experience in some trade or business (not being a profession) on their own account, or as directors of a public trading company for a like period. They should have retired from business, attended a special course at a school of law, and passed a qualifying examination in knowledge of the rules of evidence. They should have a salary of £1000 a year, and should attend as required at one court or another, thus adding constantly to their intellectual and judicial stature till they became supremely competent assistants to a presiding judge. Five of these trained and salaried jurors should go to each ordinary jury, and they were to be available, it seems, not merely in the High Court, but in the county court and at coroners’ inquests as well. Juries, the speaker explained, had developed from remote origins to their present character and functions by a series of adaptations. His present proposal would merely adapt the system afresh so as to get the best value from it, and so as to ensure to litigants the fullest and most careful consideration of their cases. Other speakers who followed were not so sanguine. Many feel that a juror should be paid his reasonable expenses, but they deprecate the institution of a class of professional jurymen who would contract fixed ideas and acquire an official point of view while losing the commonsense outlook which is so valuable a corrective in the administration of justice. The defects of the existing jury system are many. Jurors have no individual responsibility ; they give no reasons for their verdict ; their verdict as such is not subject to appeal. Many men who are summoned to serve on a jury are so deeply concerned over the enforced neglect of their business that they cannot give proper attention to their high judicial functions. Nor were these the only criticisms of the jury system uttered at Sheffield. It was said that jurors tend to reflect the popular prejudices of the
ANATOMY.
THE TEACHING OF SURGICAL As advance in medicine takes place we see new an intricate methods of diagnosis devised, the chemica changes underlying many diseases revealed, th resources of physical science called upon for treat ment, the horizon of bacteriological and immunologica science ever enlarging. No perfunctory method o study will now serve to equip the medical student fo He must go through his future work in life. Th. strenuous, exacting, and prolonged course. curriculum becomes more and more crowded as the specialists in the different branches of medicine clain to have each his own subject embodied in it. This process of inclusion must inevitably reach a limi beyond which it is inadvisable to go, for it is necessary to train practitioners who, as the subdivision o medical knowledge proceeds, preserve a broac outlook, free from all trace of those obsessions whicl beset the enthusiastic worker in a limited field Indeed, it is questionable whether it would not b( in the interests of the public and their doctors ii some curtailment of the medical curriculum wert not to be enforced even now. This applies almost a much to the basic sciences of anatomy and physiology as to the more recent growths of biochemistry and radiography. Anatomical knowledge is indeed necessary for diagnosis and for the surgical operator, but it may well be asked by the reader of such a book as that by Prof. DEAVER1 on " Surgical Anatomy of the Human Body " whether already too much is expected of the student. Here is a treatise on anatomy written by a surgeon with the surgeon’s needs in view. It is beautifully illustrated ; the pictures are realistic in the impressions they give. Everything the surgeon could conceivably desire to know, every relation which could possibly be of importance to him is described and figured. It is an exhaustive treatise on surgical anatomy, it is wellnigh perfect of its kind-but it is a book of 2168 pages in three large volumes. Should a student during the clinical years be expected to read such a large volume ? Should it be necessary, after two years’ study in the dissection room, for him to read it ? Now that the teaching of anatomy in the earlier years is in the hands of specialists it is essential for instruction in so-called surgical anatomy to be continued later, for until the student has some clinical knowledge he cannot get a grasp of surgical problems. But when it comes to arranging the scope of such a course, difficulties arise. For the future surgeon an accurate and deep knowledge of anatomy is essential. Most inaccessible structures are
apt suddenly
to
assume
surgical importance
as
the understanding of disease becomes more exact. The development of pituitary surgery, the introduction of splanchnic anaesthesia, illustrate how the most abstruse anatomical relations enter into practical everyday operating. But for the future general practitioner too extensive a course of surgical anatomy may deprive him of clinical opportunities which will not recur. It might be a wise policy for instruction in surgical anatomy to be restricted so as to comprise only that which is helpful in the diagnosis of disease or necessary for the performance of the common operations and especially those urgent procedures which every doctor may be called upon to carry out. Those on whom it falls to devise medical curricula should insist upon the instillation of principles, upon 1 Surgical Anatomy of the Human Body. Second edition. By John B. Deaver, M.D., Sc.D., LL.D., F.A.C.S., Surgeon in Chief to the Lakenau Hospital, Philadelphia; Emeritus John Red Barton, Professor of Surgery, University of Pennsylvania. London: William Heinemann. 1927. Vol. i., pp.551; vol.ii., PP. 854 ; vol. iii., pp. 763. 8 guineas the set.
broad generalisations, and a wide outlook. Detailed information can always be obtained from books; for this purpose the only essential is for the worker to know of the existence of such knowledge and where it can be obtained. If the newly qualified practitioner has absorbed the basic principles of his art, if advanced demonstrations have opened up for him a vista of the refinements of science without clogging his perception with needless detail, if, in fact, he approaches his work with the right mental attitude and equipment, defects in special knowledge will not handicap him in his dealings with his patients. They can be remedied easily by reference to trustworthy sources of information.
A CRITIC OF THE JURY SYSTEM. AT the latest of the provincial meetings of the Law Society, held at Sheffield recently, a member read a paper on The Jury System : Its Cause and Cure, in which he criticised as unsuitable and unsatisfactory the present system under which it is left to juries to assess damages upon allegations of negligence in the certification of lunatics. The critic proposed to substitute trial of such cases in camera before a special tribunal consisting of a medical practitioner, a solicitor, two trained professional jurymen, and (as chairman) a barrister or judge. Evidently some of the recent decisions of juries at the expense of certifying doctors have awakened surprise and misgiving outside the ranks of the medical profession. The trained professional jurymen whom the speaker at Sheffield had in mind were to be a new type. They were to be persons who had had 15 years’ experience in some trade or business (not being a profession) on their own account, or as directors of a public trading company for a like period. They should have retired from business, attended a special course at a school of law, and passed a qualifying examination in knowledge of the rules of evidence. They should have a salary of £1000 a year, and should attend as required at one court or another, thus adding constantly to their intellectual and judicial stature till they became supremely competent assistants to a presiding judge. Five of these trained and salaried jurors should go to each ordinary jury, and they were to be available, it seems, not merely in the High Court, but in the county court and at coroners’ inquests as well. Juries, the speaker explained, had developed from remote origins to their present character and functions by a series of adaptations. His present proposal would merely adapt the system afresh so as to get the best value from it, and so as to ensure to litigants the fullest and most careful consideration of their cases. Other speakers who followed were not so sanguine. Many feel that a juror should be paid his reasonable expenses, but they deprecate the institution of a class of professional jurymen who would contract fixed ideas and acquire an official point of view while losing the commonsense outlook which is so valuable a corrective in the administration of justice. The defects of the existing jury system are many. Jurors have no individual responsibility ; they give no reasons for their verdict ; their verdict as such is not subject to appeal. Many men who are summoned to serve on a jury are so deeply concerned over the enforced neglect of their business that they cannot give proper attention to their high judicial functions. Nor were these the only criticisms of the jury system uttered at Sheffield. It was said that jurors tend to reflect the popular prejudices of the