514 SEPT.

3,
TEACHINGOFPHYSICS
p h y s i c s
w i l l s erve our
p urp os e j us t as w el l and at t h e s ame
t i me add i nt eres t and
p rac t i c al advant ag e.
Th e under-
g raduat e s h oul d l earn t o ap p rec i at e t h e us e of p h y s i c al
met h ods i n medi c i ne and ac q ui re a b as i c k now l edg e on
w h i c h t o b ui l d s h oul d h e l at er t ak e up s ome b ranc h w h i c h
i s c l os el y
as s oc i at ed w i t h a p art i c ul ar f orm of medi c al
p h y s i c s . It may b e as w el l t h at t h e b as i c s c i enc es s h oul d
not s eem t o b e t oo w el l
def i ned;
medi c i ne h as no i nt eres t
i n art i f i c i al b arri ers b et w een t h e
s c i enc es ,
and
p h y s i c al
c h emi s t ry and b i op h y s i c s c annot b e i g nored b ec aus e t h ey
h ave b een arb i t rari l y p l ac ed on s ome b orderl i ne. We s h af l
c ert ai nl y not s ol ve t h e real p rob l ems of t h e l eng t h eni ng
s y l l ab us ,
t h e
urg e t o g et
on w i t h t h e
t h i ng s t h at w i l l b e
us ef ul ,and t h e need t o el i mi nat e t h e i nes s ent i al
b y i ns i s t i ng
on t h e s t at us
q uo.
Onc e t h e s t udent h as emb ark ed on h i s medi c al c areer
t h e c ont i nuat i on of h i s s c i ent i f i c educ at i on s h oul d
s urel y
b e made an
i nt eg ral p art
of h i s
t rai ni ng
rat h er t h an a
p re-
l i mi nary
t o i t . Th e medi c al s t udent s et s out t o do medi -
c i ne;
h e
reg ards
a
g ood
deal of w h at h e i s
t aug h t i n h i s
p rec l i ni c al
c ours e as
b ei ng
di vorc ed f rom t h i s
ob j ec t . It
i s t oo of t en
merel y
an ob s t ac l e i n t h e
p at h
of h i s
p rog res s
t ow ards mat t ers of real i nt eres t . He h as t o- day t o over-
c ome c ons i derab l e di f f i c ul t i es t o b e al l ow ed t h e op p ort uni t y
t o s t art at al l ,and at t h i s
s t ag e
i s
eag er
f or i ns t ruc t i on i n
s ub j ec t s
t h at s eem t o h i m t o h ave an ob vi ous medi c al
ap p l i -
c at i on. Wh en
y ou
s t art out t o h eal t h e s i c k i t i s a l i t t l e
di s c ourag i ng
t o f i nd
y ours el f c onf ront ed b y a Wh eat s t one
b ri dg e
and a
p os t - of f i c e
b ox.
Dr.
Henry Yel l ow l ees ( 19 46 )
s t art s h i s admi rab l e and
del i g h t f ul
b ook w i t h t h e s ent enc e,
" Is up p os e t h at t h e mos t
s i g ni f i c ant ,
i f not t h e mos t
memorab l e,day of a medi c al
s t udent ' s c areer i s t h at on w h i c h h e
f i nal l y emerg es f rom
t h e
p rec l i ni c al p eri od,
and Ih ave
al w ay s
f el t t h at t h e
oc c as i on of h i s f i rs t i nt roduc t i on t o c l i ni c al w ork mi g h t
w el l b e mark ed
b y
s ome
ap p rop ri at e c eremony ." It h i nk
t h at t h i s i s a t rue
p i c t ure
of t h e
p os i t i on,
b ut i t c ont ai ns
s ome ref l ec t i on on our met h od of
p res ent at i on of t h e b as i c
s c i enc es as medi c al
s ub j ec t s .
Adj us t ment
of t h e
Sy l l ab us
Pos t g raduat e
s t udent s
emb ark i ng
on a p h y s i c s c ours e f or
a
di p l oma
i n medi c al
radi ol og y
c an b e h eard one af t er
anot h er
deny i ng f ami l i ari t y
w i t h t h e p h y s i c s t h at t h ey w ere
t aug h t
s o f ew
y ears
b ef ore. No
h os p i t al p h y s i c i s t
" as s umes
a
k now l edg e
of
p h y s i c s eq ual
t o t h at of t h e f i rs t M.B."
w h at ever t h e
reg ul at i ons may s ay ,b ec aus e h e k now s f rom
s ad
exp eri enc e
t h at h e c an do no s uc h t h i ng . Th i s i s
s ome i ndi c at i on of t h e f ai l ure t o ens ure t h at t h e t rai ni ng
does at l eas t c ons i s t ent l y p rovi de a s ound t h oug h el emen-
t ary k now l edg e
of
p h y s i c s . Is i t p os s i b l e t h at t h e reas on
s o
many
ret ai n s o l i t t l e i s t h at t h ei r i nt eres t w as not
eng ag ed;
and c oul d t h e
g eneral educ at i onal res ul t h ave
b een ac h i eved w i t h medi c al
p h y s i c s of more i nt eres t t o
t h e s t udent and a
g reat er deg ree of us ef ul nes s t o h i m
duri ng
h i s c l i ni c al t rai ni ng ?
If w e as s ume t h at t h e
p res ent
met h ods do ac h i eve t h ei r
mai n
ob j ec t
of
devel op i ng
a s c i ent i f i c out l ook and p ro-
mot i ng
a
w ay
of
t h oug h t ,g i vi ng due al l ow anc e t o t h e
vari ed ab i l i t i es of t h e s t udent s t o ab s orb s uc h t eac h i ng ,
t h en ref orm mus t b e
c aut i ous l y ap p l i ed t o s ee t h at none
of t h i s i s l os t . If w e as s ume t h at t h ey do not ac h i eve even
t h i s
end,
t h en ref orm i s
urg ent l y
needed.Th ere w oul d s eem
t o b e s ome reas on f or doub t w h et h er t h e
p res ent arrang e-
ment s of t h e
t eac h i ng
of
p h y s i c s
are i n f ac t ni c el y adj us t ed
t o
p roduc e
t h e des i red res ul t . No
emp h as i s i s p l ac ed i n
t h e
s y l l ab us
on t h e
devel op ment
of t h e
al l - i mp ort ant
at t i t ude of mi nd; t h i s i s l ef t t o t ak e c are of i t s el f i n t h e
g eneral c l as s i c al ap p roac h t o t h e s ub j ec t t h at i s l ai d dow n,
or rat h er i s l ef t t o t h e i ndi vi dual t eac h ers on w h os e vary -
i ng k now l edg e of t h e needs of medi c i ne and w h os e
ab i l i t y t o i mp art an out l ook t o t h e s t udent al l ul t i mat el y
dep ends . Some,at l eas t ,s eem c onc erned onl y w i t h t h e
el ement ary det ai l s of h eat ,l i g h t ,s ound,el ec t ri c i t y ,and
mag net i s m.
Th e p rac t i c al ut i l i t ari an s i de of t h e i ns t ruc t i on ap p ears
s h y l y h ere and t h ere i n t h e s y l l ab us w i t h t h e ment i on of
os mos i s ,s p ec t ac l es ,mi c ros c op es ,op h t h al mos c op es ,radi o-
ac t i vi t y ,and t h ermi oni c emi s s i on. Th at no real i mp ort anc e
i s at t ac h ed t o t h es e c onc es s i ons t o t h os e w h o h ave
demanded more di rec t ap p l i c at i on of t h e p res c ri b ed s y l l a-
b us t o medi c i ne i s s h ow n i n t h e l i s t of exemp t i ons w h i c h
al l ow s a b oy f rom s c h ool t o avoi d al l s uc h i ns t ruc t i on.
Th e i nt roduc t ory p arag rap h of t h e s y l l ab us of t h e U ni ver-
s i t y of London f or " Ph y s i c s ( i nc l udi ng Mec h ani c s ) " does
not s ay ,"Th e s ub j ec t i s t o b e t reat ed as a b as i s f or t h e
devel op ment of a c ri t i c al ,reas oni ng ,s c i ent i f i c out l ook and
i l l us t rat ed as f req uent l y as p os s i b l e b y means of di rec t p rac -
t i c al examp l es of t h e ap p l i c at i ons of p h y s i c s i n medi c i ne;
a k now l edg e of mat h emat i c s on t h e p art of t h e s t udent i s
an i nes t i mab l e advant ag e i n at t ai ni ng t h i s ob j ec t ,t h e exp eri -
ment al ap p roac h b ei ng t h e onl y ot h er met h od l i k el y t o b e
s uc c es s f ul ." Ins t ead t h ere ap p ears t h e rat h er dreary s en-
t enc e,"' Th e w h ol e s ub j ec t i s t o b e t reat ed i n an el ement ary
manner,t h e mat h emat i c al devel op ment i n no c as e ext endi ng
b ey ond a k now l edg e of q uadrat i c eq uat i ons and el ement ary
t ri g onomet ry ."
It h as ,Ib el i eve,b een s ug g es t ed t h at t h e f i rs t M.B.mi g h t
b e ab ol i s h ed and t h at i ns t ruc t i on i n c h emi s t ry ,p h y s i c s ,and
b i ol og y b e g i ven al ong w i t h t h at i n anat omy and p h y s i o-
l og y i n one p rec l i ni c al c ours e. More t i me i s w ant ed f or
t h e s ec ond M.B.,and i t i s t h oug h t t o g ai n i t at t h e exp ens e
of t h e f i rs t . Th e t i me w oul d p res umab l y b e g ai ned b y t h e
el i mi nat i on of muc h of w h at i s now t aug h t i n t h e b as i c
s c i enc es and reg arded b y s ome as unnec es s ary ,and w h at
remai ned w oul d b e more c l os el y rel at ed t o p rac t i c al ,every -
day medi c al needs . If every s t udent rec ei ved a s ound s c i en-
t i f i c t rai ni ng at s c h ool ,i f anat omy and p h y s i ol og y w ere
not al l ow ed t o s w amp t h e c h emi s t ry ,p h y s i c s ,and b i ol og y
t h at remai ned,and i f t eac h i ng w ere done i mag i nat i vel y
and l arg el y b y t h e exp eri ment al met h od,us i ng di rec t c l i ni -
c al ap p l i c at i ons f or i l l us t rat i on,t h ere w oul d b e muc h t o
b e s ai d f or t h e s ug g es t i on. Th e s t udent w oul d s t art of f
doi ng s omet h i ng more nearl y rel at ed t o medi c i ne; h e mi g h t
b et t er ap p rec i at e t h e need f or t h e p h y s i c s h e w as b ei ng
t aug h t . Th ere are,h ow ever,a l ot of " i f s " c onc erned.
Ido not k now h ow s uc h an arrang ement w oul d w ork ,
b ut w h i l e f undament al c h ang es are b ei ng di s c us s ed t h ere
are s t i l l ref orms w h i c h s urel y s h oul d b e made at onc e.
Sui t ab l e Ins t ruc t ors
Th e
t eac h i ng of p h y s i c s t o medi c al s t udent s s h oul d never
b e s ol el y i n t h e h ands of a uni vers i t y p h y s i c s dep art ment ,
b ut s h oul d i nc l ude i ns t ruc t i on f rom t h os e w i t h p ers onal
p rac t i c al k now l edg e of t h e medi c al ap p l i c at i ons of p h y s i c s
and w h o t h ems el ves eng ag e i n res earc h i n p h y s i c s i n rel a-
t i on t o b i ol og y or medi c i ne. Th ere i s a g row i ng b and of
h os p i t al p h y s i c i s t s avai l ab l e w h o w oul d b enef i t f rom a
c l os er c ont ac t w i t h medi c al s t udent s and al s o f rom t h e
nec es s i t y t o revi ew t h e ap p l i c at i ons of t h ei r b ranc h of
s c i enc e t o medi c i ne on i t s b roades t b as i s . Th ere s h oul d b e
no
exemp t i ons
f rom a c ours e of t h i s k i nd. Hos p i t al p h y s i -
c i s t s c oul d
p roduc e many f as c i nat i ng s ub j ec t s f or i nc l us i on
i n i t . Some
k now l edg e
of
radi oac t i vi t y ,of t h e us e of
BR ITISH
MEDICAL JOU R NAL
514 SEPT.
3,
19 49 TEACHINGOFPHYSICS
SEPT.3,19 49 TEACHINGOFPHYSICS BR JMoui 515
radi oac t i ve i s ot op es as t rac ers i n t h e i nves t i g at i on of p h y s i o-
l og i c al and p at h ol og i c al p rob l ems ,and of t h e us e of a
Gei g er- Mul l er c ount er as a c l i ni c al i ns t rument are ob vi ous
examp l es . It i s not di f f i c ul t at t h e s ame t i me,f or i ns t anc e,
t o c onvey s omet h i ng of t h e p ot ent i al i t i es of t h e q uant i t at i ve
met h od,s omet h i ng of p res ent i deas of t h e nat ure of t h e
at om or t h e w ay s i n w h i c h exp eri ment al c onf i rmat i on of
t h eory h as b een ob t ai ned.
Las t y ear Iw as f ort unat e enoug h t o s ee t h e res ul t s of
an exerc i s e s et b y Dr.Jos ep h Hami l t on t o a s t udent c l as s
i n t h e U ni vers i t y of Cal i f orni a at Berk el ey i n w h i c h eac h
s t udent w as req ui red t o s et dow n i n det ai l an ac c ount of
an e p eri ment al i nves t i g at i on t h at h e w oul d l i k e t o c arry
out w i t h a radi oac t i ve t rac er mat eri al and t h at h ad not
b een s ug g es t ed b ef ore i n t h e l i t erat ure. Nearl y al l w ere
reas oned,p rac t i c al ,ori g i nal s ug g es t i ons ,and s ome w ere s o
w el l p res ent ed and of s uc h meri t t h at t h e op p ort uni t y of
c arry i ng out t h e exp eri ment w as b ei ng p rovi ded t o t h es e
s t udent s . It w oul d b e h ard t o f i nd a b et t er examp l e of
t h e us e of a met h od of ap p l i ed medi c al p h y s i c s as a means
f or p romot i ng a s c i ent i f i c out l ook . It i s di f f i c ul t t o b el i eve
t h at s uc h a res ul t c oul d b e ob t ai ned w i t h t h e met h ods
of t rai ni ng s t udent s i n op erat i on i n mos t s c h ool s i n t h i s
c ount ry at t h e p res ent t i me.
Prac t i c al Ap p l i c at i ons
Il l us t rat i ons of t h e ap p l i c at i on of p h y s i c s i n medi c i ne
nat ural l y oc c ur t o me p ri mari l y i n t h e f i el d of radi at i on,
b ut many ot h ers c an b e f ound. Some of t h e ap p l i c at i ons
of op t i c al p ri nc i p l es ,s uc h as t h e meas urement of ery t h ro-
c y t es b y t h e h al oes t h ey c aus e around a s ourc e of l i g h t ,
or mi c ros c op y f rom t h e op t i c al mi c ros c op e t o t h e f as c i na-
t i ons of t h e el ec t ron mi c ros c op e,w h ere a vi rus may b e
s h ow n b y means of a g ol den s h adow ,are g ood examp l es .
El ec t roni c s i s i nvadi ng medi c i ne on a l arg e s c al e and p ro-
vi des p os s i b l e demons t rat i ons f or t h e s t udent i n s uc h vari ed
f i el ds as neurop h y s i ol og y ,t h e meas urement of radi at i on,
t h e us e of h eari ng - ai ds ,el ec t roc ardi og rap h y ,mus c l e- nerve
s t i mul at i on, c ol ori met ers , p Hmet ers , and even t h e
demons t rat i on of s urg i c al op erat i ons b y t el evi s i on.
An ob vi ous i l l us t rat i on i n s urg ery i s t h e i mp ort anc e and
means of c ount erac t i ng t h e p h y s i c al f ac t ors t h at i nt erf ere
w i t h res p i rat i on and c i rc ul at i on w h en t h e c h es t i s op ened.
Th e dermat ol og i s t may b e i nt eres t ed i n t h e p h y s i c al f orc es
w h i c h p roduc e al t erat i ons i n s k i n p i g ment ,t h e p s y c h i at ri s t
i n el ec t ri c - s h oc k t h erap y ,t h e op h t h al mol og i s t i n t h e s p ec t ral
s ens i t i vi t y of t h e vari ous p art s of t h e ret i na and t h e met h ods
of i nves t i g at i ng ni g h t - b l i ndnes s ,t h e h aemat ol og i s t i n el ec -
t rop h ores i s ,t h e ort h op aedi c s urg eon i n t h e t raj ec t ori es of
s t res s es i n b one,and t h e ot ol ary ng ol og i s t i n t h e c omp l i c a-
t i ons of ves t i b ul ar mec h ani s ms .
Th e di f f i c ul t y i s not t o f i nd i l l us t rat i ons b ut t o di s t i ng ui s h
among s t t h e w eal t h of mat eri al avai l ab l e t h os e mos t l i k el y
t o h ol d t h e s t udent ' s i nt eres t and p rovi de h i m w i t h an
ap p rec i at i on of t h e underl y i ng p h y s i c al p ri nc i p l es c on-
c erned,w h i l e unob t rus i vel y devel op i ng h i s p ow ers of c ri t i -
c al exami nat i on of a p rob l em and h i s des i re and ab i l i t y
t o t es t a t h eory b y exp eri ment - i n f ac t ,p rovi di ng h i m w i t h
t h e c ap ac i t y f or l og i c al ,i mp ers onal ,ob j ec t i ve t h oug h t .
R EFER ENCES
Bri t i s h Medi c al Journal ( 19 45) . 2 , 12 3.
Gl as s er,0 .( 19 44) . Medi c al Ph y s i c s . Year Book Pub l i s h ers Inc .,
Ch i c ag o.
Sh ry oc k ,R .H.( 19 48 ) . Th e Devel op ment of Modern Medi c i ne.
Gol l anc z ,London.
Yel l ow l ees ,H.( 19 46 ) . Th e Human Ap p roac h . Ch urc h i l l ,London.
Nova et V et era
SIR WILLIAM GOWER S
Si r Wi l l i aam Gow ers . By Mac donal d Cri t c h l ey . ( Pp . 118 ;
i l l us t rat ed. 17 s . 6 d.) London: Wi l l i am Hei nemann Medi c al
Book s . 19 49 .
Dr.Mac donal d Cri t c h l ey ' s l i f e of Si r Wi l l i am Gow ers ,w h o w as
b orn i n 18 45,rec ords t h e c h i ef event s of h i s c areer,i l l umi nat es
t h em w i t h t h e remi ni s c enc es of t h os e w h o w ere p ri vi l eg ed t o
b e h i s p up i l s ,and revi ew s h i s c ont ri b ut i ons t o medi c i ne. He
w as b orn t h e s on of a Hac k ney s h op k eep er,and i t w as p rob ab l y
t h e ac c i dent of h i s f at h er' s earl y deat h and h i s w i dow ed
mot h er' s mi g rat i on t o t h e nei g h b ourh ood of Oxf ord t h at s et
h i s f oot on t h e f i rs t rung of t h e educ at i onal l adder at Ch ri s t
Ch urc h Col l eg e Sc h ool . An ap p rent i c es h i p t o a g eneral p rac t i -
t i oner i n Es s ex w as h i s ent ry i nt o t h e p rof es s i on t o w h i c h h e
w as des t i ned t o c ont ri b ut e s o muc h . Th ereaf t er U ni vers i t y
Col l eg e Hos p i t al and s ub s eq uent l y t h e Nat i onal Hos p i t al made
up t h e s p h ere of h i s ac t i vi t i es . He p l ay ed no g reat p art i n
medi c al af f ai rs : neurol og y f i l l ed h i s w ork i ng l i f e,and h ob b i es ,
es p ec i al l y s h ort h and,oc c up i ed h i s s p are t i me. He di ed i n 19 15.
Gow ers w i l l b e rememb ered as a g reat c l i ni c al ob s erver.Dr.
Cri t c h l ey p oi nt s out t h at t h e earl y des c ri p t i ons of many of t h e
nervous di s eas es w h i c h w e rec og ni z e t o- day w i t h c onf i denc e
are due t o h i s ac umen. Th at t h i s h as not b een more g eneral l y
rec og ni z ed i n t h e p as t i s due t o t h e f ac t t h at many s uc h des c ri p -
t i ons w ere g i ven c as ual l y i n t h e c ours e of h i s w ri t i ng s and i t
w as of t en l ef t t o s ub s eq uent ob s ervers t o at t ac h a l ab el t o c on-
di t i ons w h i c h Gow ers h ad di s c overed.
Dr.Cri t c h l ey h as w ri t t en a val uab l e memoi r w h i c h i s s h ort
enc ug h t o mak e t h e reader w i s h f or more. Ten i l l us t rat i ons
add t o i t s i nt eres t ,and i t i nc l udes a b i b l i og rap h y .
R U SSELL BR AIN.
PIONEER SINOR THOPAEDICS
On t h e Cont ri b ui t i ons of Hug h Ow en Th omas ,Si r R ob ert Jones ,
and Joh ni R i dl on t o Modern Ort h op aedi c Surg ery . By H.
Wi nnet t Orr,M.D.; s up p l ement b y Art h ur St ei ndl er,M.D.
( Pp .2 53. 1 5s .) Oxf ord: Bl ac k w el l Sc i ent i f i c Pub l i c at i ons .
Th es e t h ree men,p romi nent i n t h ei r g enerat i on,h ave added
muc h t o ort h op aedi c s urg ery ,and a c ri t i c al exami nat i on of t h e
w ork of any one of t h em w oul d b e s uf f i c i ent t o s at i s f y mos t
w ri t ers . Dr.Orr h as w i s el y not at t emp t ed t o j udg e t h e val ue
of al l t h ei r c ont ri b ut i ons t o ort h op aedi c s ,b ut h as c onf i ned h i m-
s el f l arg el y t o Th omas ' s w ri t i ng on res t ,and t h e reac t i ons of
Jones and R i dl on t o t h es e p ri nc i p l es . It i s f or t h i s reas on
t h at Jones and R i dl on ap p ear not as ori g i nal w ork ers t h ems el ves
b ut rat h er as p al e moons ref l ec t i ng t h e l i g h t of t h e s un. Th e
b ook enab l es t h e reader t o ob t ai n a p i c t ure of t h e rel at i ons
b et w een t h e t h ree men,and i t b ri ng s t o t h e not i c e of t h e
p rof es s i on onc e ag ai n t h e g reat advanc es made b y Th omas
and t h e di f f i c ul t i es h e enc ount ered.
Dr.Orr' s s t y l e of w ri t i ng l eads on oc c as i on t o s ome di f f i c ul t y .
He does not f i ni s h h i s remark s on one p ers onal i t y b ef ore di s -
c us s i ng ot h ers ,and t h i s res ul t s i n a c ert ai n amount of c onf u-
s i on w h i c h c oul d readi l y h ave b een avoi ded. He ri g h t l y
c ri t i c i z es t h e many modi f i c at i ons and i mp rovement s of t h e
Th omas s p l i nt t h at h ave b een s ug g es t ed duri ng and b et w een
t h e t w o w orl d w ars ,and s t at es t h at i t w oul d h ave b een p ref er-
ab l e i f t h e aut h ors of t h es e s ug g es t i ons h ad l earned h ow t o us e
t h e s p l i nt i n t h e c orrec t manner. Di rec t l y af t er t h i s c on-
demnat i on Dr.Orr exp l ai ns t h at "t h e us e of s k el et al f i xat i on
p i ns ( not w i res ) i n p l as t er of Pari s rep res ent s t h e onl y s ub -
s t ant i al i mp rovement i n t h e t ec h ni q ue f or mai nt ai ni ng c orrec t
l eng t h - p os i t i on- and
res t - s i nc e Th omas h i ms el f ."
It i s unf ort unat e t h at w i t h a s ub j ec t
i n w h i c h t h e f ac t s c oul d
b e s o readi l y c onf i rmed t h ere s h oul d b e a f ew ob vi ous mi s t ak es .
For examp l e,Th omas w as not t rai ned b y h i s mat ernal unc l e
Ow en R ob ert s ,of St .As ap h ,at t h e Li verp ool Work h ous e Hos -
p i t al ,as s t at ed i n t h e t ext ,and i t i s ob vi ous t h at Dr.Orr meant
Si r As t l ey Coop er
and not Si r As h l ey Coop er. It i s h ard t o
def i ne t h e exac t c h arac t er of t h i s b ook ; i t i nc l udes many
ext rac t s f rom ot h er aut h ors and f ol l ow s c l os el y t h ei r op i ni ons .
T.P.MCMU R R AY.