Welsh Journals

each and all of these sciences afford valuable mental training, the necessary limitations of time and opportunity sug- gest, that for the medical student the claims, not only of the preliminary sciences, but even of anatomy and physiology must be subordinated to practical ends. Even so, there is now general agreement that a high standard must be set in all these subjects, and that the thoroughness of the teaching must not be inferior to that given in a University course in the same sciences, though the special needs of the medical student may require concentration. Of certain parts of the subject matter, while the steady progress of knowledge has enabled the preliminary sciences to take their proper place in the curriculum, much of the improvement in the teaching of physiology and anatomy, and especially the educational value of these subjects, is due to the influence of the Universities and their constituent colleges, which set a standard of efficiency that the ordinary medical schools have been obliged to imitate. The teaching of medicine and surgery, which centres round certain large general hospitals, is on an entirely different footing. Here the methods of tradition have still a firm hold and though the teaching of the subsidiary sciences, such as bacteriology and experimental pathology, often attains a high level, the same cannot be said either of the formal lectures in medicine and surgery or of the practical instruction which supplements attendance at lectures. This defect is now generally recognised both in England and in America. In the case of England the recent report of the Royal Commission on University Education in London is most enlightening. The Commissioners agree that English methods of clinical instruction must be supplemented by a completely re- organised system of formal instruction in the purely professional subjects. The essentials of the new system are the appointment of professors and assistant professors who would devote most, if not all, their time to teaching and to scientific research. This would enable the teaching staff to keep abreast of modern develop- ments, and, by co-ordinated effort, to train their students in methods of pre- cision and in the practical application of the results of research. In order that this may be done, it is necessary that the position of a professor or assistant pro- fessor should be sufficiently attractive to retain the services of the very best men, who are now forced to earn a living by competing for consulting practice to the detriment of their capacity both for teach- ing and research. This policy has actually been adopted within the last few months at the Johns Hopkins University, Baltimore, which has been enabled by the munificence of the Rockefeller Education Board to re-organise the departments of medicine and surgery, and to make the professors of these sub- jects and their staffs completely indepen- dent of fees from private patients. The probable effect of such changes in the quality of advanced medical teaching has been fully discussed in the report on the University of London, which should be carefully studied by all interested in the development of the Welsh medical student. Certain supplementary consider- ations are equally important. Under present conditions in England, medical students are taught medicine and surgery by busy consultants who, with few exceptions, are year by year more deeply immersed in private practice and, by the very pres- sure of their reputation and popularity, are precluded from2[either undertaking research or devoting the necessary time