Welsh Journals

to tutorial work. The quality of the con- sultant's teaching therefore tends to suffer as his reputation increases, and unfor- tunately this is not the only ill result of the present system. The pressure of private practice gradually diminishes the energy which can be devoted to the operating theatre and hospital ward. The patients suffer as the quality of hospital work de- clines, while the students are not only deprived of competent teaching but, at their most impressionable age, too often lack the opportunity of seeing their teacher's work at its best. To this, of course, there are notable exceptions, as some consultants are able to carry on a large private practice without neglecting their duty to hospital and medical school. Still even in these cases students are unconsciously imbued with vulgar ideals that professional success comes only by way of Harley Street and competing private practice-ends which are too often dependent rather on the initial advantages of wealth and social gifts than on pro- fessional knowledge or intellectual pre- eminence. The practical importance of these indirect results are patent to those who were fortunate to have among their teachers a great physician or surgeon who, like John Hunter, placed devotion to hos- pital work and research before the damned guinea," and thus enabled a generation of students to realise that material success is not the only end to which their energies should be directed. Another and greater drawback inherent in the present educational system is due to the fact that consultants are solely concerned with the treatment of disease. Any training medical students may receive from them in preventive medicine is limited to a few platitudes concerning the control of the common infectious diseases, though it is on the recognition by the general practitioner of the missed case," and of the early stages of such diseases as phthisis that progress in medi- cine largely depends. In respect to infant nurture, the hygiene of school children, the advantages or otherwise of physical exercises, dietetics and the general regimen of health, the teachers of medicine are for the most part strangely silent, with the lamentable result that the horizon of the general practitioner is limited by a sick bed and a medicine chest. It is true that a small proportion of men take post- graduate courses in hygiene, but unfor- tunately this does not imply more than a nodding acquaintance with preventive medicine. The subjects for the D.P.H. Examinations are a strange olla podrida of elementary physical science, sanitary law and the hygiene of environment, which together form a very imperfect equipment for officers who should take considerable responsibility for the health of the community. Hence it is that municipal activity is often either absent or ill directed and that energy is so often misapplied as, for instance, when disin- fection is allowed to supersede preventive measures based on the natural history of the particular disease under considera- tion. Though these deficiencies in medical education have long been patent, it is sub- mitted that both the medical profession and the State have now a common interest in demanding a remedy. Doctors are paid by the State a large annual sum for undertaking responsibility for the health of an increasing section of the community, and have therefore a personal interest in preventing rather than in treating disease. The State, having put its hand to the plough, cannot turn back until it has per- fected its scheme of medical treatment, and it hardly needs saying that true states-