As medical knowledge is not complete or stationary at any one time, it follows that the medical curriculum must undergo frequent changes and can hardly ever be satisfactory. There are many critics of medical education, but few whose criticism is constructive, and it is little wonder that this is so, because the curriculum must be adaptable enough to provide for frequent and drastic alterations. The lowering of the standard of general education which has taken place in the entrance examination is a retrograde step. If the practice of medicine is to remain a learned and liberal profession, doctors must be men of general culture, for which a good knowledge of the mother tongue and of English literature is undoubtedly essential. A mind devoted purely to science is as ill-balanced as one absorbed in the humanities. We believe that the subjects of physics, chemistry, botany, and zoology should be taught to students before they enter on the medical course proper, because these subjects are subordinate and tend to overload the medical curriculum. Sir James Mackenzie says that the present defects in medical knowledge are fully apparent only to those who are actually engaged in the work of general practice, and they have the knowledge necessary to remedy these defects, but unfortunately the general practitioner has little authority. Probably every doctor in practice can recall how at his medical school physiology or chemical physiology, or pathology, or bacteriology, or some other study was given prominence far beyond its merit in the curriculum. No subjects except anatomy, practice of physic, surgery, and obstetrics should be advanced beyond a moderate standard, and advanced courses should be post-graduate and adapted for such as wish to specialise. If it is to be otherwise, six years will not suffice for a course of study for graduation, for it will be easy to provide a ten years’ course to attempt to satisfy the demands of specialists who think that their own particular spoke is the most essential part of the wheel. When a student has survived all this his diffused knowledge will not make him readier to combat the ordinary ailments with which he will contend in practice. A great amount of time is wasted, too, by attendance at systematic lecture which can be curtailed with great advantage in favour of clinical instruction. There are many excellent text-books quite as useful as systematic lectures which are an anachronism. If these defects were removed a five years’ course of study would not be too short. The Medical School of New Zealand has now instituted a six years’ course of study. Might not the sixth year be made a compulsory post-graduate course with advantage?

We have before us a highly instructive memorandum written by Sir James Mackenzie and the staff of the St. Andrew’s Institute for Clinical Research. This memorandum shows the classification of disease is at present based largely upon morbid changes which have been discovered and studied after death, and these changes do not indicate the real nature of disease, but are only the terminal changes of a long preceding illness. Physicians look in the living for the physical signs to correlate them during life with the morbid state found at death. A majority of sick people have not such gross pathological and structural changes. There is a tendency, too, in orthodox teaching to take the most prominent symptom or sensation and consider it to be the disease. Sir James Mackenzie advocates research by general practitioners into the early stages of disease, and the keeping of records. A case should be records in such a way as this: Chief complaint. Associated sensations. Physical signs. Provisional diagnosis. Treatment. After-history. The St. Andrew’s Institute is adapted for the teaching of general practitioners. “It is a remarkable fact,” writes Sir James Mackenzie, “that though the vast majority of medical students become general practitioners, no attempt is made to teach them how to make use of their opportunities in general practice, and no hint is ever given them that the phases of disease which they will meet will be different from that which they have seen in the hospitals. There is an urgent need for a definite course of teaching and training students in their last year how they should conduct their practices.”

The profession in New Zealand is justly proud of its Medical School, which has now attained a high degree of efficiency, and it might be to the advantage of the School and the Faculty, and of the profession throughout New Zealand, if questions relating to medical training could be discussed occasionally at the annual meeting of the Medical Association.

As medical knowledge is not complete or stationary at any one time, it follows that the medical curriculum must undergo frequent changes and can hardly ever be satisfactory. There are many critics of medical education, but few whose criticism is constructive, and it is little wonder that this is so, because the curriculum must be adaptable enough to provide for frequent and drastic alterations. The lowering of the standard of general education which has taken place in the entrance examination is a retrograde step. If the practice of medicine is to remain a learned and liberal profession, doctors must be men of general culture, for which a good knowledge of the mother tongue and of English literature is undoubtedly essential. A mind devoted purely to science is as ill-balanced as one absorbed in the humanities. We believe that the subjects of physics, chemistry, botany, and zoology should be taught to students before they enter on the medical course proper, because these subjects are subordinate and tend to overload the medical curriculum. Sir James Mackenzie says that the present defects in medical knowledge are fully apparent only to those who are actually engaged in the work of general practice, and they have the knowledge necessary to remedy these defects, but unfortunately the general practitioner has little authority. Probably every doctor in practice can recall how at his medical school physiology or chemical physiology, or pathology, or bacteriology, or some other study was given prominence far beyond its merit in the curriculum. No subjects except anatomy, practice of physic, surgery, and obstetrics should be advanced beyond a moderate standard, and advanced courses should be post-graduate and adapted for such as wish to specialise. If it is to be otherwise, six years will not suffice for a course of study for graduation, for it will be easy to provide a ten years’ course to attempt to satisfy the demands of specialists who think that their own particular spoke is the most essential part of the wheel. When a student has survived all this his diffused knowledge will not make him readier to combat the ordinary ailments with which he will contend in practice. A great amount of time is wasted, too, by attendance at systematic lecture which can be curtailed with great advantage in favour of clinical instruction. There are many excellent text-books quite as useful as systematic lectures which are an anachronism. If these defects were removed a five years’ course of study would not be too short. The Medical School of New Zealand has now instituted a six years’ course of study. Might not the sixth year be made a compulsory post-graduate course with advantage?

We have before us a highly instructive memorandum written by Sir James Mackenzie and the staff of the St. Andrew’s Institute for Clinical Research. This memorandum shows the classification of disease is at present based largely upon morbid changes which have been discovered and studied after death, and these changes do not indicate the real nature of disease, but are only the terminal changes of a long preceding illness. Physicians look in the living for the physical signs to correlate them during life with the morbid state found at death. A majority of sick people have not such gross pathological and structural changes. There is a tendency, too, in orthodox teaching to take the most prominent symptom or sensation and consider it to be the disease. Sir James Mackenzie advocates research by general practitioners into the early stages of disease, and the keeping of records. A case should be records in such a way as this: Chief complaint. Associated sensations. Physical signs. Provisional diagnosis. Treatment. After-history. The St. Andrew’s Institute is adapted for the teaching of general practitioners. “It is a remarkable fact,” writes Sir James Mackenzie, “that though the vast majority of medical students become general practitioners, no attempt is made to teach them how to make use of their opportunities in general practice, and no hint is ever given them that the phases of disease which they will meet will be different from that which they have seen in the hospitals. There is an urgent need for a definite course of teaching and training students in their last year how they should conduct their practices.”

The profession in New Zealand is justly proud of its Medical School, which has now attained a high degree of efficiency, and it might be to the advantage of the School and the Faculty, and of the profession throughout New Zealand, if questions relating to medical training could be discussed occasionally at the annual meeting of the Medical Association.