41

BIOLOGY

FOR

MEDICAL

STUDENTS~

By J. BRONTE GATENBY. HE proper people to determine what courses should be taught to medical students are the medical members of medical school councils, for the professional biologist is rarely in a position to envisage the whole medical course, and to attempt adequately to strike a balance. The writer has been a non-medical member of the Trinity College Dublin Medical School Committee for over ten years and has constantly been reminded by the agenda of the meetings of this body of the increasing claims for the better teaching of specialist courses in the later years of the medical students' curriculum. It is quite evident that any time wasted, or thought to be wasted, must be saved and given to more important work. In the articles which appeared in this Journal in November, 1932, (e.g., that of Dr. Harvey) some remarks have been made on this topic, and it is one which has interested the writer very much fo.r many years. The writer knew intimately the courses of biology for medical students at both Oxford and London, and has always been impressed with the amount of practically useless material which is included in these courses at these two great English Universities. The English biologist would clahn that his course gave a broad foundation upon which a good medical edifice ought to be erected, but it is certainly hard to explain what use an intimate knowledge of the names of the appendages of the crayfish could be to medical students. Such examples could be multiplied many times from English University courses. It is certainly true that many English students pass through these courses m a state of mental muddle. It is impossible to justify the teaching of the anatomy of the frog and rabbit with comparative anatomical nomenclature as a training for human anatomy with its own special nomenclature. There appear to be two ways in which the time now spent on biology might be saved: one would be to teach the medical biology m schools, or in pre-medical courses; the other, to spread the material already taught over other courses in non-biological departments. There is no doubt that some of the bigger English schools could take up such work successfully (some already do so), but the smaller schools both in England and in this country could not afford either the teachers or the equipment necessary. In Ireland the universities must provide facilities for the medical student's biology. The other alternative would be to spread the absolutely necessary material over various other departments, and this alternative will be referred to below. It must be remembered that the teaching of the first year students is an exhausting and expensive business for the biology departments; any scheme which would side-track them elsewhere would be welcomed by the writer. The Trinity term now largely devoted to medical students could be better used for students of pure biology.

T

42

IRISH JOURNAL OF MEDICAL SCIENCE

It was once said to the writer by the Dean of the School of Physic in Trinity College, that the medical course was the greatest education that a university could offer. Few, if any, will disagree with this statement. No course offers such a medley of human knowledge, and no profession brings the individual into contact with human beings in such an interesting manner. There is, therefore, before us the aspect of the medical doctor as an educated man, and not only as a technician. We must never lose sight of this, and the following remarks are made with this proposition constantly in view. How many medical men need to use what they were taught of Mendel, of sex-determination or the minute historical structure of the gonads? But is there a senior medical man in this country who would wish the fundamentals of biology to be unknown to our young medical men who go out to various parts of the world, and on whom the prestige of our medical schools rests? This is our side. Dr. Harvey's address puts another. " Every now and then," he writes, " I hear some doctor whose general skill I perhaps know to be of a high order complain that he knows nothing of skins." This cannot of course be blamed on the Departments of Botany and Zoology, and while it is painful that a doctor should not know the difference between a specific roseola and a purpura it would also be very regrettable if he did not know the modern theory of sex-determination, or the embedding of the ovum. It appears to the writer that the fault in Dr. Harvey's example lies with the hospital from which the doctor became a qualified medical practitioner. The problem really comes down to what sort of medical man we wish to produce. It is quite obvious that an obstetrician can be an excellent man at his profession without having heard that there is such a thing as the decidua. In the same way it is quite true that an intelligent grocer's curate could be trained in the simple operation of removing a tonsil so .as not to injure the patient excessively. The reader may ask: What do you want to teach in a zoology department? The following paragraphs give what is considered tim necessary grounding. 1. A rapid survey of a number of animal types designed to educate the student in the diversity of living organisms from the comparative anatomical point of view. 2. A basis for protozoology, i.e., some training in the structure and practical appearance of various free-living and paxasitie protozoa. 3. A basis for parasitology--the insect and helminth parasite~ 4. Some comparative embryology as a basis for human embryology. Early development. 5. Cytology, i.e., the manner of formation of eggs and sperms, and fertilisation. Sex-determination. 6. Heredity--Mendelism, Lamarckism, Darwinism, etc. 7. The oestrua cycle.

BIOLOGY

FOR

MEDICAL

STUDENTS

43

Of course, the material set forth in the above paragraphs may not be zoology, but in view of the fact that 99% of it has been produced by zoologists one may assume for the sake of the present discussion that it is zoology. The writer also assumes that it will be agreed that a qualified medical man should have attended the lectures upon all the topics above, possibly excepting those in paragraph 1. And now we come to the alternative mentioned above, viz., the possibility of teaching this in other departments. No. 1 being purely educative (or largely so) could be dispensed with. Nos. 2 and 3 could be easily included in the work of the Pathology and Bacteriology Departments. No. 4 could go to the Human Anatomy Department. Nos. 5 and 7 to the Physiology Department. No. 6 could be rapidly reviewed in the Pathology Department, in connection with the inheritance of certain diseases. Of course it is quite true that few pathologists are capable of giving training in any aspect of heredity, nor do physiologists, as we know most of them to-day, deal with cytology, nor do human anatomists usually teach invertebrate embryology, from which the materials for an embryological basis are best drawn. These are mere details, and could be got over by employing assistants who were specially trained for the purpose. The advantage of the above plan would be that tbe~ medical students would be taught much of the necessary biological material in their more senior years when they would be better able to appreciate it. A few more lectures would need to be given in the Departments of Human Anatomy, Pathology and Bacteriology and Physiology, in order to include this new material, but this would not be an insuperable barrier. This change, if it could be brought about, would mean that the " breaking-in " of the junior medical student in the biological outlook would fall very largely upon the Departments of Physiology and Human Anatomy; but since it is already the custom to allow Irish medical students to begin dissecting the human cadaver before they have passed in botany and zoology, this should not matter very much. Moreover, some students begin their physiological training before they have passed in biology. Lectures in physiology could begin with some general information of a wide biological nature, and in the Department of Human Anatomy the work could be graded in the same manner. The success of this plan would obviously depend upon such grading from the simple to the more complicated. One very important objection could be advanced against the above plan. That is that the biological material offered in this somewhat haphazard manner could not be said to form a foundation. While this would probably be true, it would be offset by two things: one, that much of the material of a biological nature would be presented at a later and more mature stage, and another, that more time would be made for the specialist courses at the later stage in the curriculum. This, after all, seems to be what is wanted.