MANY HIPPOCRATIC RETURNS
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265 MANY HIPPOCRATIC RETURNS MANY HIPPOCRATIC RETURNS THE LANCET LONDON: : SATURDAY, AUGUST 31, 1940 THE usual students’ number, stout with detailed information, has no place in a paper-saving world; nor would it be really useful, when the medical schools, bursting through the tradition of centuries, are improvising merrily to meet the needs of our shifting time. But though as a guide to the beginner a students’ number on the old plan would ’do no more than perplex and delay, as a chronicle of an exceedingly interesting period it may have a value of a different sort. The story is told in the pages which follow. No attempt has been made this year to give a full account of the academic opportunities offered by the various universities; we have been content to give these in a brief outline, noting in each case the authority from whom further details may be sought. The printer has divorced the war-time experiences of each university from the more workaday matter by a lead or slight gap, symbol perhaps of an inspiriting dislocation. At first glance it may seem strange that the account of the Defence Services should have shrunk, at this time of all others, to a mere paragraph each; but this is an index of regimentation. At present the Forces are only appointing medical personnel as temporary officers, and admitting them through a single portal. In the medical schools some of the makeshifts are decidedly makeshifts, but others carry in them the seeds of a new kind of growth. By no means all the results of the upheaval have been disastrous or sterile of promise. Of the teaching hospitals some, after a preliminary scattering, have called their students home again to the parent hospital; some have planned a new and intriguing curriculum which takes the students on a round of hospital visits; and some, a little disgruntled at missing the fun, have stayed at home with a depleted teaching staff since the beginning of the war. Few of the pro- vincial schools, for example, have been evacuated, though all have made plans to move if necessary. Directors of transferred schools have been serpents of cunning in securing opportunities for their students to see everything instructive in the neighbourhood. In the London area the students have usually been distributed to two or three sector hospitals and it has been found that what one hospital lacks another can supply. This chopping and changing has proved stimulating rather than unsettling. The students like the increased clinical opportunities-and there are plenty of patients, even if they have to be hunted out in scattered lairs. Some have found the lack of outpatients in sector hospitals a disadvantage, but this is often outweighed by the greater variety of clinical experience in the wards. To one school at least the war has brought an increased scope, its students having the run of three large L.C.C. hos- pitals, one of them being the postgraduate school at Hammersmith. This gives them access to a much larger number of beds than they would have in peace-time. Students of several medical schools have become resident in the sector hospitals where the teaching members of their staff are living. This return to the Hippocratic tradition, with teacher and pupil living in close fellowship, is valued by students and possi- bly by their teachers. Not long ago a contributor to our " In England Now " columns (LANCET, July 27, p. 111) drew attention to the wide gulf which usually sunders the student of today from any inti- mate intellectual friendship with his teachers. He went on to describe a meeting of the British Medical Student Association, held in Manchester last May, at which many of the speakers expressed a leaning towards an earlier university ideal in which the rela- tion of teacher and student was far more intimate than it is today. In the emergency measures they are seeing this ideal fulfilled. The dean of St. Mary’s suggests that in time to come it may seem the only innovation of moment in medical education during the war years. This is taking, perhaps, too dark a view; the dean of St. George’s, though he feels that too great a subdivision of students for teaching purposes is incompatible with an ordered syllabus, believes that the present compromise is working satisfactorily and may well form the basic plan for future arrangements. And the dean of St. Thomas’s recognises several useful lessons for the future; preliminary medical subjects and anatomy might well be taught, he thinks, in two or three large centres, not only as a measure of economy but in order that instruction might be more uniform. The teaching of physiology, he points out with great justice, should inform the whole medical course and not be tucked away in the watertight compartment imposed by the second M.B.; the physiology depart- ment ought to be an integral part of the medical school. This is echoed in the suggestion, made by the provost of the Welsh National School of Medi- cine, that the later months of anatomy and physio- logy teaching should be linked with an introduction to clinical study. The dean of St. Thomas’s also dreams of more rational allotment of time in the various phases of training and a curriculum no longer loaded with dead wood. Now—when the medical schools are in an experimental mood and even the examining bodies must be more vulnerable than usual-seems as good a time as any for him to reach for his little hatchet. SEPTICÆMIA AND BACTERÆMIA SEPTICAEMIA, as WHITBY 1 points out in a compre- hensive review, is a clinical state characterised by bacteria in the blood, sustained fever and other evidence of systemic infection, and carrying with it a grave prognosis. Under this generic term should probably be included pyaemia, which has more often an obvious primary focus and is accompanied by metastatic abscesses, the sequel usually of a septic thrombo-phlebitis extending from the site of the primary lesion. Septicaemia must be sharply differ- entiated from bactereemia, which, as RYLE 2 has explained, implies nothing more nor less than the presence of bacteria in the blood; it is a pathological finding rather than a clinical condition, but it may too readily be accepted as a septicaemia by the clinician who pays more attention to the bacterio- logist’s report than to the patient’s clinical state. 1. Whitby, L. E. H. Brit. J. Surg. July, 1940, p. 124. 2. Ryle, J. A. Lancet, 1938, 2, 867.
Transcript of MANY HIPPOCRATIC RETURNS
265MANY HIPPOCRATIC RETURNS
MANY HIPPOCRATIC RETURNS
THE LANCETLONDON: : SATURDAY, AUGUST 31, 1940
THE usual students’ number, stout with detailedinformation, has no place in a paper-saving world;nor would it be really useful, when the medicalschools, bursting through the tradition of centuries,are improvising merrily to meet the needs of our
shifting time. But though as a guide to the
beginner a students’ number on the old plan would’do no more than perplex and delay, as a chronicleof an exceedingly interesting period it may have avalue of a different sort. The story is told in the
pages which follow. No attempt has been madethis year to give a full account of the academic
opportunities offered by the various universities; wehave been content to give these in a brief outline,noting in each case the authority from whom furtherdetails may be sought. The printer has divorced thewar-time experiences of each university from themore workaday matter by a lead or slight gap,symbol perhaps of an inspiriting dislocation. Atfirst glance it may seem strange that the accountof the Defence Services should have shrunk, at thistime of all others, to a mere paragraph each; but thisis an index of regimentation. At present the Forcesare only appointing medical personnel as temporaryofficers, and admitting them through a single portal.In the medical schools some of the makeshifts are
decidedly makeshifts, but others carry in them theseeds of a new kind of growth. By no means allthe results of the upheaval have been disastrous orsterile of promise. Of the teaching hospitals some,after a preliminary scattering, have called theirstudents home again to the parent hospital; somehave planned a new and intriguing curriculum whichtakes the students on a round of hospital visits;and some, a little disgruntled at missing the fun,have stayed at home with a depleted teaching staffsince the beginning of the war. Few of the pro-vincial schools, for example, have been evacuated,though all have made plans to move if necessary.Directors of transferred schools have been serpentsof cunning in securing opportunities for their studentsto see everything instructive in the neighbourhood.In the London area the students have usually beendistributed to two or three sector hospitals and ithas been found that what one hospital lacks anothercan supply. This chopping and changing has provedstimulating rather than unsettling. The studentslike the increased clinical opportunities-and thereare plenty of patients, even if they have to be huntedout in scattered lairs. Some have found the lackof outpatients in sector hospitals a disadvantage, butthis is often outweighed by the greater variety ofclinical experience in the wards. To one school atleast the war has brought an increased scope,its students having the run of three large L.C.C. hos-pitals, one of them being the postgraduate schoolat Hammersmith. This gives them access to a
much larger number of beds than they would havein peace-time.
Students of several medical schools have become
resident in the sector hospitals where the teachingmembers of their staff are living. This return to the
Hippocratic tradition, with teacher and pupil livingin close fellowship, is valued by students and possi-bly by their teachers. Not long ago a contributorto our " In England Now " columns (LANCET, July27, p. 111) drew attention to the wide gulf whichusually sunders the student of today from any inti-mate intellectual friendship with his teachers. Hewent on to describe a meeting of the British MedicalStudent Association, held in Manchester last May,at which many of the speakers expressed a leaningtowards an earlier university ideal in which the rela-tion of teacher and student was far more intimatethan it is today. In the emergency measures theyare seeing this ideal fulfilled. The dean of St.
Mary’s suggests that in time to come it may seemthe only innovation of moment in medical educationduring the war years. This is taking, perhaps, toodark a view; the dean of St. George’s, though hefeels that too great a subdivision of students for
teaching purposes is incompatible with an orderedsyllabus, believes that the present compromise is
working satisfactorily and may well form the basicplan for future arrangements. And the dean of St.Thomas’s recognises several useful lessons for thefuture; preliminary medical subjects and anatomymight well be taught, he thinks, in two or three
large centres, not only as a measure of economy butin order that instruction might be more uniform.The teaching of physiology, he points out with greatjustice, should inform the whole medical course andnot be tucked away in the watertight compartmentimposed by the second M.B.; the physiology depart-ment ought to be an integral part of the medicalschool. This is echoed in the suggestion, made bythe provost of the Welsh National School of Medi-cine, that the later months of anatomy and physio-logy teaching should be linked with an introductionto clinical study. The dean of St. Thomas’s alsodreams of more rational allotment of time in thevarious phases of training and a curriculum no longerloaded with dead wood. Now—when the medicalschools are in an experimental mood and even theexamining bodies must be more vulnerable thanusual-seems as good a time as any for him to reachfor his little hatchet.
SEPTICÆMIA AND BACTERÆMIA
SEPTICAEMIA, as WHITBY 1 points out in a compre-hensive review, is a clinical state characterised bybacteria in the blood, sustained fever and otherevidence of systemic infection, and carrying with ita grave prognosis. Under this generic term shouldprobably be included pyaemia, which has more oftenan obvious primary focus and is accompanied bymetastatic abscesses, the sequel usually of a septicthrombo-phlebitis extending from the site of the
primary lesion. Septicaemia must be sharply differ-entiated from bactereemia, which, as RYLE 2 hasexplained, implies nothing more nor less than thepresence of bacteria in the blood; it is a pathologicalfinding rather than a clinical condition, but it maytoo readily be accepted as a septicaemia by theclinician who pays more attention to the bacterio-logist’s report than to the patient’s clinical state.
1. Whitby, L. E. H. Brit. J. Surg. July, 1940, p. 124.2. Ryle, J. A. Lancet, 1938, 2, 867.
