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teaching in medicine followed in such a hospital as St. Bartholomew's, nor with the opportunities for observing disease which its wards, out-patient rooms, and post-mor- Our students are not encouraged to think of ex- tem room afford to the students. amination (c.f. Dr. Manson's address, p. 8) as their reason for including or omitting particular forms of disease from their consideration, and we are confident that the large majority of our students use the opportunities of the hospital to the full, and endeavour not merely to pass examinations, but to study every part of their profession in the most thorough possible way. Most students during their course have the opportunity of seeing cases of malarial fever, dysentery, endemic, hoematuria, with occasional ex- amples of other diseases which begin in the tropics. Malarial fever occurs in Essex and in Kent, and besides these local cases, numerous imported examples from all parts of the tropics are seen either in the wards or out-patient rooms. Tropical dysentery is necessarily rarely imported except in its chronic form. No year passes without several cases of chronic dysentery coming under the observation of our students.
The methods of investigation of disease are taught to all students, and these, with their application to cases in the wards, fit them to observe unfamiliar forms of disease which may subsequently come under their observation when they reach the tropics. All that can be done in London to prepare students to understand the clinical features, pathological nature, and principles of treatment of such diseases already forms part of their course of study here.
In our Medical School no one is allowed to lecture in medicine who is not in active observation of his subject. Tropical diseases must be seen to be thoroughly under- stood, and a student well trained in the principles of medicine and the observation of disease will find no difficulty in adding a knowledge of such diseases to his acquirements when he sees them. Every student here can go into the wards to test from actual cases the statements of his teachers; and any teaching not subject to this daily criti- cism is of little scientific value.
Dogmatic teaching in tropical disease, which there was no opportunity of testing at the time by a comparison with actual cases, would do harm, instead of good, to the student.
Good lectures, with cases at hand, in Bombay, Hong Kong, Singapore, Uganda, Sierra Leone, Accra, and George Town, Demerara, would be valuable to medical offi- cers arriving in these localities, and might wisely be established, and attendance on them encouraged, or required, for the Colonial Medical Service. Such lectures, ou the spot, would probably lead to real advances in the knowledge of tropical diseases and their treatment. Lectures in London would be interesting as reminiscences, but could be of little value as scientific teaching, and might, by establishing preconceived ideas of an obsolete type, do actual harm to the student when he arrives in the tropics.
The opportunity of seeing cases of disease begun in the tropics and their post- mortem examination must be greater at Netley and Haslar than at most London Hospi- tals, and would, of course, be useful; but lectures and attendance at these hospitals would be less valuable than instruction given in the natural habitat of the diseases.
A course of instruction in bacteriology, such as all students may now attend at St. Bartholomew's, is an important preparation for the investigation of epidemic and endemic disease, at home or in the tropics.
Persons interested in particular subjects are constantly applying for additions to the medical curriculum, and maintain that it cannot be complete without them. Dr. Manson's proposal ought, however, to be rejected on stronger grounds than that there is not time for the lectures he proposes. It would be difficult to add another course to the curriculum, but the one he suggests would not even be useful, and is unscientific in its method.
Any regulation making special instruction in tropical diseases compulsory before Applying for appointment to the Colonial Medical Service might tend to seriously diminish the number of applicants, and a London course on such diseases would, for the reasons given above, fail to add to the competence of the candidates.
We are, &c.,
(On behalf of the Medical Officers and Lecturers of St. Bartholomew's Hospital),
T. W. SHORE, M.D.,
12378.
SIR,
No. 25.
GENERAL MEDICAL COUNCIL to COLONIAL OFFICE.
(Received June 3, 1898.)
General Medical Council Office, 299, Oxford Street, London, W.,
June 2, 1898.
WITH reference to your communication of 11th March,* with regard to special instruction in tropical diseases in medical schools, I am directed to inform you that this Council has had the question under its serious consideration, that a Committee of the Council was appointed to fully enquire into it, and that on the receipt of a report from this Committee, the General Medical Council, on 31st ultimo, adopted the following resolution:-
"That the Council inform the Secretary of State for the Colonies that, while the Council is not prepared to recommend that tropical medicine should be made an obli- gatory subject of the ordinary medical curriculum, it deems it highly desirable, in the public interest, that arrangements should forthwith be made by the Government for the special instruction in tropical medicine, hygiene, and climatology of duly qualified medical practitioners who are selected for the Colonial Medical Service, or who other- wise propose to practise in tropical countries."
I have, &c.,
1239 3.
SIR,
No. 26.
H. E. ALLEN,
Registrar.
YORKSHIRE COLLEGE, LEEDS, to COLONIAL OFFICE. (Received June 3, 1898.)
The Yorkshire College, Leeds,
Medical Department, June 2, 1898. REFERRING to your letter of March 11th* (26144/97), I am desired by the Board of the Medical Department of the Yorkshire College to say that this Board fully appreciates the importance of your letter and of Mr. Secretary Chamberlain's pro- posal, and the desirability of systematic instruction in tropical medicine being given at the medical schools more fully than has always been the case hitherto, preparatory to that clinical study which the Secretary indicates that he is prepared to provide at certain Government hospitals.
This Board has resolved to institute at the Yorkshire College School of Medicine a short course of lectures on the causes, symptoms, and treatment of diseases peculiar to tropical climates, with demonstrations and microscopical examination of morbid specimens. It is proposed that the first course shall be delivered in the next summer session, and that certificates of attendance shall be given to such students as duly attend it.
As soon as Mr. Chamberlain's arrangements are completed for affording the oppor- tunities of clinical study referred to, I trust that information about them may be sup- plied to this medical school.
I have, &c.,
12421.
SIR,
THOMAS SCATTERGOOD,
Dean of the Medical Department, Yorkshire College.
No. 27.
EDINBURGH UNIVERSITY to COLONIAL OFFICE. (Received June 4, 1898.)
University of Edinburgh, June 3, 1898. REFERRING to the letter, 26144/97, of 11th March, 1898,* which I had the honour to receive, I have thought it would be of interest to you to learn that the Faculty of Medicine of this University has prepared a scheme, which has now been approved by the
Warden.
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Senatus, for special education in tropical diseases and for the granting of certificates to graduates who have satisfactorily availed themselves of this instruction.
While we are not in a position to give sufficient clinical instruction in tropical diseases, we believe that the scheme of which I enclose a description will afford ample opportunity for an education which will place the certificate holders in the most favour- able position for entering upon clinical studies.
Enclosure in No. 27.
I am, &c.,
THOMAS R. FRASER,
Dean.
LECTURESHIP ON DISEASES OF TROPICAL CLIMATES.
THE Faculty of Medicine having received the following representation (see letter of 11th March, 1898) from Her Majesty's Secretary of State for the Colonies, have, after consideration, resolved to submit the following recommendations to the Senatus:
(1) That a Lectureship in Tropical Diseases shall be instituted, in which the course of instruction shall extend over not less than twenty or more than twenty-five meetings, and shall consist of lectures and demonstrations and other practical work, the number of meetings for each to be afterwards arranged.
(2) That the fee for this course shall be £2 2s.
(3) That two such courses shall be given in cach year, one in the winter and the other in the summer session.
(4) That the class shall be open only to Bachelors of Medicine and Masters in Surgery, or Bachelors of Medicine and Bachelors of Surgery, and to undergraduates who have passed the final examinations for these degrees.
(5) That a special certificate shall be given to those members of the class who have not only attended with regularity and performed the work of the class in a satisfactory manner, but who, previously to joining the class, have received a special training in practical bacteriology, including the practical study of the micro-organisms of tropical diseases.
(6) That a special certificate shall be granted only to graduates in medicine and surgery of this University.
8478.
No. 28.
THOMAS R. FRASER,
Dean of the Faculty of Medicine.
COLONIAL OFFICE to TREASURY.
[Answered by No. 29.]
Downing Street, June 14, 1898.
SIR,
I AM directed by Mr. Secretary Chamberlain to transmit to you, to be laid before the Lords Commissioners of the Treasury, the accompanying copy of a memorandum as to the formation of a School of Tropical Medicine at the Seamen's Hospital, at which the medical officers of the Colonies and Protectorates administered by the Colonial Office and Foreign Office respectively could receive special instruction in the treatment of tropical diseases.
Mr. Chamberlain attaches great importance to the formation of this School, and he would be glad to learn with as little delay as possible whether their Lordships would be prepared to agree to the proposal that, for the reasons given in the memorandum, a moiety (say, £1,500 to £2,000) of the initial cost, which is estimated at £3,550, should be detrayed from Imperial funds.
I am, &c.,
C. P. LUCAS.
27
Enclosure in No. 28.
PROPOSALS FOR THE TRAINING OF COLONIAL MEDICAL OFFICERS.
Mr. Chamberlain has for some time noted with concern the high death rate among Europeans in the British West African Dependencies.
În 1895 the number of European officials on the Gold Coast was 175; of these 17 died and 24 were invalided.
In 1896 the number was 176, 15 died and 26 were invalided.
It is true that these two seasons were exceptionally unhealthy, but, for the pur- poses with which this Memorandum is concerned, account must be taken of outbreaks of fever and other specially unfavourable conditions which recur from time to time.
The figures given take no account of the non-official white population, among whom the mortality is at least as high, and who, for skilled medical advice, are practically dependent upon the Colonial Surgeons.
Corresponding returns for the other British Colonies in West Africa are not to hand, but it may safely be said that, with the possible exception of the Gambia, those Colonies are hardly, if at all, more healthy than the Gold Coast. It is stated on good authority that at Lagos 46 out of 140 resident Europeans lately died during a period of 15 months, and that during another period of 6 months 72 out of a white population of 200 died.
Dr. Patrick Manson, the present Medical Adviser of the Colonial Office, who has had Colonial experience, and has made a special study of tropical disease, on which he is now one of the leading authorities, has expressed a strong opinion to the effect that many lives could be saved among the white residents in these unhealthy climates if the Colonial Medical Officers were required, prior to appointment, to study tropical medicine on a regular system.
Dr. Manson, indeed, goes further. His view is that natives, equally with Europeans, will benefit by greater technical knowledge and skill on the part of those who have charge of the hospitals and dispensaries in the various Colonies and Protectorates.
At present there is no arrangement by which officers selected for medical appoint- ments in the Colonies and Protectorates administered by the Colonial Office and Foreign Office receive instruction in tropical medicine before proceeding to their stations, and, accordingly, the greater number of these officers at the beginning of their service have little or no knowledge of the diagnosis and treatment of tropical disease, though they may by the exigencies of the service (and this remark applies specially to West Africa) be placed at once in responsible positions where such a knowledge would be of the highest importance. This defect should, in Mr. Chamberlain's opinion, be made good as soon as possible, and he has carefully considered what steps should be taken for the purpose. The officers of the Army Medical Department and the Indian Medical Service are instructed in tropical medicine at Netley, while the Medical Officers of the Royal Navy receive similar instruction at Haslar.
The Secretary of State for War has been good enough to offer to make arrange- ments whereby Colonial Medical Officers shall be received at Netley for instruction, but Mr. Chamberlain had already approached the authorities of the Seamen's Hospital at Greenwich on the subject, and after a careful consideration of the matter he is convinced that the latter institution is better suited to the requirements of the Colonial Medical Service.
The reasons which have led him to decide in favour of the Seamen's Hospital are: (1) It apparently offers greater facilities than are forthcoming at Netley for con- stantly seeing and investigating acute forms of tropical disease, such as would be met with in actual practice.
(2) Dr. Manson, the Medical Adviser of this Department, is a prominent member of the teaching staff of the hospital, and therefore will be able to personally supervise the training of the Colonial Medical Officers, to advise the Secretary of State as to their capabilities and deficiencies, and to adapt the instruction given at the hospital to the exact requirements of the Colonial service.
(3) The authorities of the Seamen's Hospital will, it is understood, in the event of the scheme now under consideration taking effect, admit to their Board of Management a representative of the Colonial Office.
(4) Medical officers for West Africa are generally required at short notice, and it is therefore desirable that they should be attached to an institution where the rules as to
1918
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