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Tropical Medicine and Sanitation. When it was first founded, the University College of Liverpool gave no diploma on the subject, and instruction to students had to be furnished by the small staff of the School as well as possible under the conditions then obtaining. The staff was frequently engaged in the tropics for the purposes of following my researches on malaria, recent work on trypanosomiasis, and other researches. At that stage, too, few medical men from the tropics (who formed the majority of our students) were willing to attend the school for more than a month or two, and the various Government offices did not then lay such stress on teaching in tropical medicine as they now do. Moreover, material for teaching had not then been accumulated in large quantity by the School, and, indeed, general investigations on tropical medical subjects had not reached the great proportions which they have now attained. Hence it was possible in the early years of the School for the staff to limit its course of instruction to the academical three months (which amounts to about eleven weeks), and to repeat this course every term, that is to say, three times a year.
Since then, however, owing to the great increase of our knowledge of tropical medicine, of our material for teaching, and of the great importance attached to the subject by the public, the staff have long felt that a single term was not sufficient for the course. Of recent years particularly, we have found ourselves unable to give the students what we have to give, within that time. I cannot possibly crowd in the whole of my subjects into the fifty or sixty lectures which I give during the term at the rate of five lectures a week and Dr. Stephens and Mr. Newstead make similar complaints with regard to the subjects allotted to them. In addition to this we feel that, as all this mass of matter has to be forced into the minds of the students within so short a time, they cannot possibly assimilate it as they ought to do that, in fact, the whole process is little better than one of "cramming."
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I was indeed preparing to represent the matter to the Committee when the decisive "Report of the Visitors appointed by the Royal Colleges of Physicians and Surgeons to report upon the Course of Study and upon Examinations in Tropical Medicine" appeared. In this report, the visitors discuss the shortness of the course and say: Whatever may be the case now, it seems almost certain that in the course of time, both with increasing knowledge and modified views as to the limits of the subject, it will be impossible to teach in that short period all that should be known. And even now it appears to be doubtful if such a powerful instrument as a Diploma in Tropical Medicine should be awarded for knowledge attained in a three-months' course, especially when much of the time is occupied in re-learning the elements of haematology and facts about typhoid fever, which form the subjects of examination in the ordinary diploma for practice in the British Isles. As a matter of fact, these Diplomas in Tropical Medicine are now becoming to be considered almost as passports for a capacity to practise in the tropics; and too great importance, therefore, cannot be attached to making them such that they will really become adequate guarantees of such proficiency.
We have, therefore, carefully considered what should be done under the circum- stances, and conclude that the only feasible procedure is to extend the course to one of six months, during which full instruction can be given in place of the partial instruction now furnished. It will be remembered that the same thing had to be done in the case of Diplomas in Public Health. At first these were given after three months' courses of study; but it was quickly seen that this time was not sufficient for adequate instruction. I have therefore taken pains to furnish pro- posals for a six-months' course in Tropical Medicine, which will give the utmost value for the time expended; and my proposals, which are attached herewith, were provisionally accepted yesterday by the professional Committee of this School. In the attached documents, I begin with a short statement of the present course, and then set forth the new proposals. It will be seen that whereas the present course consists of only four lines of instruction given during three months, the enclosed will consist of no less than thirteen such lines of intruction given during the six months. Not only will the old lines of instruction be followed into a greater elaboration of detail, but a large number of new subjects essential for a well- educated medical man in the tropics will be dealt with. Thus, eleven demonstra- tions, occupying the entire afternoon, will be given on Tropical Sanitation by Professor Hope, the Health Officer of Liverpool, on such subjects as sewage farming, drains, disinfection, water supply, &c. Practical bacteriology, including bacterio- logical water and milk analysis, clinical bacteriology, &c., will be taught by a suit- able member of the University. Chemical water and milk analysis will be dealt with
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by the Professor of Bio-Chemistry of this University. The Pathology of Meat, which will enable medical men to inspect meat for food, will be taught by the Professor of Comparative Pathology. The highly important subject of Cytology and its methods will, it is hoped, be taught by the Director and Assistant Director of this University's Cancer Research Department. Meteorology will be given by the Professor of Physics, and Serum Preparation by the Professor of Comparative Pathology, while a few lectures on the classification of parasites and on occasional subjects will be given by our Professor of Zoology and by other lecturers. It will be seen that all these subjects are of vital importance to the medical man in the tropics, who as a rule cannot easily there acquire the information. Such a course will, I venture to think, be regarded as almost a complete post-graduate training for such medical men--a thing which certainly can scarcely be said of the course which we are now compelled to give.
The conditions of such a course will demand that only one shall be given every year. The most suitable months lie between the 1st October and the end of March, because, among other reasons, the Autumn term is one in which there is most clinical material in the hospitals. In the Summer term I propose that students be encouraged to attend these laboratories for researches and for practical instruction in research only under myself and the staff of the School-instruction which is always keenly desired by many of the most able medical men in the tropics. At the end of the six-months' course, I propose that the University should give an examination for a diploma, not only in tropical medicine as at present, but in tropical medicine and hygiene. The examination will be extended over all the subjects in which instruction has been given, and will occupy nearly the whole week. There will, I hope, be more than one external examiner.
The only difficulty in this programme lies in the time which will be required for it; but I do not think that this is at all insuperable. It has not proved insuper- able in the case of Diplomas of Public Health, which are often taken, not only by men practising in this country, but also by many Government medical officers. It is obvious that our proposed course need only be taken once in a life time, and I think that, under the circumstances, many medical men, including Government medical officers, will be desirous of increasing their proficiency in the manner indicated. I may point out that medical officers from the tropics are generally allowed a year or more leave, and are also frequently granted extra leave for special studies; so that I cannot see that Government interests will suffer by giving its medical employees another three months in order to obtain a complete, as against a partial, proficiency in matters so essential to their duties.
Lastly, in order to recoup the School for the additional expense which it will have to undergo in giving this instruction, I propose that it should enlarge its fee from £10 10s. Od. for the three months to £25 for the six months' course. Arrange- ments can be made by which students can take the instruction given in the second term of the session, from January to March, on a subsequent occasion, so that only three months at a time is absolutely necessary. But the instruction given in the Autumn term must be first taken, and the diploma cannot be given until the full course has been completed.
I-PRESENT COURSE.
The present course of instruction on Tropical Medicine lasts about ten weeks and is given three times every year, namely, during the Lent, Summer and Autumn
terms.
Instruction given.
2. Tropical Pathology, Parasitology and By Dr. Stephens.
Bacteriology.
1. Lectures on Tropical Medicine and By Professor Ross. Fifty lectures of
Sanitation.
one hour's duration, given at the rate of five a week for ten weeks.
Fifty lectures and demonstrations of two hours' duration, given at the rate of five a week for ten weeks.
3. Arthropodology
... By Mr. Newstead. Thirty lectures and demonstrations of two or more hours' duration, given at the rate of three a week for ten weeks.