the lancet

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THE LANCET.

LONDON: SATURDAY, AUGUST 31, 1929.

PHYSIOLOGY AND THE MEDICALCURRICULUM.

IN an issue devoted to considering the training ofthose who are entering the medical profession, whilethe main information will bear relation to the curri-

culum which they have to follow, some reflectionsupon the general circumstances of the medical careerare pertinent. During the year that has passedsince the last issue of the Students’ Numberthe calling of medicine has been in no way

seriously altered either in relation to the train-

ing of students or in relation to their future

professional prospects. The medical curriculumhas been unaltered since its inter-arrangementlast year following the resolution of the GeneralMedical Council passed some seven years ago ; the

overcrowded schedules of study have been somewhateased by the introduction of order, while the spiritshown by the licensing bodies when various detailswere under discussion is of good omen for futurechanges. And changes there must be both in theacademic and the practical equipment of doctors insympathy with the growth of professional knowledge,and with the increasing intimacy between medicinein particular and science in general. The professionalopportunities remain as good and as numerous asheretofor, but the difficulties of the medical careercannot be said to have abated in any marked way.And it is gratifying to be able to say that the

opportunities, because of their vast implications,outweigh the disadvantages. It is with the fullknowledge that the life of the doctor is a finer careerthan ever, because of the far-reaching and well-supported promises of good which the development ofmedicine are giving, that we welcome into our ranksthe recruits who will take their places next Octoberin the schools.The anticipation that the studies preliminary to

a medical course, as well as those directly connectedwith that course may always need variation is justifiedby the proceedings before the Section of Physiologyand Biochemistry of the British Medical Associationwhich we publish in another column. Prof. F. R.FRASER, in opening a discussion on the place whichhuman physiology should occupy in the training ofmedical students, spoke exactly words which ought tobe appreciated alike by the medical profession and thepublic that it serves, and indicated an aspect of

medical teaching whose importance will be seen readily.He pointed out that human physiology must largelyconcern itself with the interaction of systems, and thatknowledge of it means comprehension of human

adjustments to environment, the great responsibilityof medicine being to ascertain the causes of mal-

adjustments, in order to remove or mitigate results.

This view of the study of physiology introduces thequestion of how much should be taught to the medicalstudent and at what place in his curriculum. All willagree that human physiology should be taught to thestudents before admission to the wards, but how muchof what may be termed the science of living is itpossible toimpart while formal instruction is still

being given in lie processes of, say, the respirationand the c;irculation ? The more the student has achance of enlarging his knowledge of normal manbefore being introduced to the abnormalities of injuryand disease, the easier will it be for him to appreciatehuman adjustments, and therefore to follow withintelligence the teaching of the clinicians who are hispreceptors in the wards. Says Sir GEORGE NEWMAN,in his Annual Report for the Year 1928, as ChiefMedical Officer of the Ministry of Health, whichhas just appeared (see p. 480): "There must bea standard in our minds, and that standard should notbe one of disease or pestilence, but of health andphysiology. It is true there is no fixed line of healthfor a nation any more than for an individual. Butwe must formulate an average, a norm, as best we

may, establishing it on physiological facts.... Out ofour rapidly extending knowledge of physiology andanthropometry we must build up a normal conceptionof body size, weight, and height, body temperature,the pulse-rate, blood pressure, the respiration-rate,lung capacity and chest expansion, muscle output,nerve efficiency, sense faculty, and mental tests. Wemust aim to bring the race, by means of the individual,steadily towards this standard." In these words wehave a fine confirmation of Dr. FRASER’S thesis, and,further, an eloquent plea for an altered attitudetowards the training of medical students in humanphysiology. And evidence in the same direction iscontained in the pithy notes of Dr. G. F. WALKER, ofLeeds, who writes in another column (see p. 481) outof his experience as medical tutor at the

University. That changes in the indicated directionhave already been made quietly and with success incertain schools shows that we have here no drasticmeasure of reform to clamour for, but only such aninter-arrangement of work as has already taken

place along many other lines.And the influence of such a modified curriculum

should have wide-reaching effect. Human physiologyis to-day becoming a study of real public interest,while in State, private, and public schools alikeit is now felt that a knowledge of the funda-mentals of biology should be in the possession ofall. It is easy to see that with a public thus growingup to familiarity with normal standards, the doctorwill find it far easier to obtain a comprehension of hisefforts, of his difficulties, and, perhaps, of his successeswhen dealing with the variations of and divagationsfrom the normal which constitute disease. But it is

necessary, for his counsel to have prompt appeal,that he himself should understand the normal cir-cumstances from which a default has occurred.Undoubtedly the plea made in the Section of Physio-logy and Biochemistry that more attention shouldbe paid to the normal in the earlier stages of medicaleducation is a forcible one. When this happensand when at the same time the public, in accordancewith a routine upbringing, acquire also a knowledgeof normal biology, a great deal of unnecessary dissen-sion between the medical profession and the publicwill be abated, a quickening of public interest in theorganisation of our calling will follow, and we shallwitness more prompt manifestations of willingnesson the part of the public authorities to use medicalservice intelligently.