439MEDICAL SCHOOLS

Montgomery in the St. Mungo-Notman chair of patho-logy tenable at the Royal Infirmary, and retirals atthe end of this session will lead to one or two changesamong those in charge of non-professorial clinical teach-ing units. The junior teaching staff has been augmentedby several additions in the lecturer grade to the establish-ments of individual departments. The principal develop-ment of the year in the medical school has been the

opening of a new department of surgery at the WesternInfirmarv. This building, which is contiguous with theGardiner Institute of Medicine, will offer greatly increasedfacilities for postgraduate study and research. In theveterinary school, the animal hospital and associatedbuildings for. clinical instruction are now nearing comple-tion, and the facilities for veterinary instruction andresearch have been further augmented by the purchaseof a farm within reasonable distance of the clinicaldepartments. There have been no major changes in themedical curriculum, but an organisation has now beenset up whereby senior medical students may, during theirvacations, obtain an attachment to a general practi-tioner for a period of at least a fortnight.

At the UNIVERSITY OF ST. ANDREWS instruction in thesubjects of the clinical years of study is given at Dundee,while the premedical and preclinical subjects may bestudied either at St. Andrews or at Dundee. The courseof study lasts six years. The annual intake of studentsto the faculty of medicine is limited to between 70 and80 to ensure that the hospital facilities available aresufficient to allow of adequate clinical instruction beinggiven to each undergraduate. The laboratory accom-modation in both preclinical and clinical years has beenrecently extended and provides excellent facilities forstudents. Both at St. Andrews and Dundee there areresidences which accommodate undergraduates from allfaculties. Medical students in their early years are

encouraged to reside in these to make contact withundergraduates of other faculties.

IRELAND

At the UNIVERSITY OF DUBLIN considerably fewerstudents are being admitted to the premedical year nextOctober. Exemption from the premedical year will begranted only in special cases. Full-time chairs in clinicalmedicine and clinical surgery have been created this year.Changes are being made in the arrangements for clinicalteaching in the hospitals. Reconstruction of the patho-logical and physiological laboratories is in progress, anda new laboratory for pharmacology is to be providedwhich, it is hoped, will be ready by the summer term of1956. Further modifications in the arts course formedical students include the introduction of a seriesof lectures on the history of medicine.

The SCHOOLS OF SURGERY, DUBLIN, includingCarmichael and Ledwich Schools, are attached by charterto the Royal College of Surgeons in Ireland. The collegeadmits to the preregistration classes approximately 100students each year. The normal method of entrance isby competition in the preliminary examination, but alimited number of places is given to those with excep-tional qualifications and to certain students selected bythe Colonial Office to which all colonial students shouldapply, because, owing to limitation of numbers, theycannot be admitted to the entrance examination. Nearlyall students take the Irish Conjoint Board’s examinationbut some take in addition the London examination.The Schools were inspected by delegates from LondonUniversity last year and as a result were " recognised "for a further period of five years. Students are medicallyexamined at the start of the preregistration yearand again before the start of the clinical years. Twodoctors give free medical care to students and thereare a men’s warden and a lady dean of residence tohelp students in obtaining suitable accommodation andin other ways. The playing fields of 16 acres and thepavilions are among the best in Dublin. During the pastyear the laboratory space for chemistry and physics hasbeen doubled, two rooms for advanced work have beenadded to the anatomy department, and much additional

apparatus obtained for the pathology, physiology, andphysics department. In addition a large room has beenconstructed for the Men’s Union.

The ROYAL COLLEGE OF SURGEONS IN IRELAND isin the unique position of being by charter an under-graduate school of medicine undertaking the full trainingin the basic sciences and in the preclinical and clinicalcourses. In the college buildings in Stephen’s Green inthe middle of the city are the laboratories for biology,physics, and chemistry, and for biochemistry, physiology,and pathology, as well as an unusually large anatomydepartment, five large lecture-theatres for formal lectures,examination, administration, and reception rooms, theCollege library, a restaurant for the students, and theUnion common-rooms for men and women. For mid-wifery and gynaecology any of the three well-known Dublinmaternity hospitals are available to college students andfor general hospital work any of the ten Dublin clinicalhospitals and the usual specialist hospitals are available.The Students’ Union caters for about twelve othersocieties-scientific, musical, dramatic, fencing, boxing,&c.-and most of these compete with visiting universities,Irish or otherwise. Students are examined radiologicallyon entrance, tuberculin-tested and, if they wish it,given B.c.G. The radiological examination is repeatedbefore commencing clinical work. The great majorityof students take the examinations of the Irish ConjointBoard and a few take the English Conjoint and theLondon University examinations.

At QUEEN’S UNIVERSITY, BELFAST, the number ofentries to the medical school each year is restricted to108, of which up to 20 places are reserved for the schoolof dentistry. Priority is given to applicants whoseparents are normally resident in Northern Ireland, and anumber of places is reserved for selected candidates fromGreat Britain and overseas. Details of the entrancerequirements may be obtained from the secretary,Faculty of Medicine, 25, University Square, Belfast, orfrom the clerk of admissions, Queen’s University, Belfast.The professorial staff was increased during the year bythe appointment of Prof. G. W. A. Dick to the chair ofmicrobiology. The new Institute of Clinical Science,which was opened in May, 1954, provides exceptionalfacilities for the clinical teaching of undergraduates andof research for postgraduates. The student-health-serviceclinic continues to provide a comprehensive service forall students at the University. Routine medical examina-tion and Mantoux testing is compulsory for first-yearstudents. All students have an annual chest radiograph,and this facility is also offered to the staff. A lodgingsdepartment has been added to the. other auxiliariesof the service. A roster of inspected and classified lodgingsis maintained and all non-resident students outsidehostels are now accommodated through this department.

The NATIONAL UNIVERSITY OF IRELAND has collegesin Dublin, Cork, and Galway.

In UNIVERSITY COLLEGE, DUBLIN, the feeling is thatthe difficulties of medical education increase apace.The techniques of examination become more specialisedand the schools are too often swayed by pressure groupswho consider that the latest, and, as it has often provedin the past, ephemeral, outlook should be made the basisof teaching. In an effort to protect the student, Univer-sity College proposes to reduce the number and scope ofthe examinations between the second and final, and,while ensuring that the student is acquainted with allbranches of medicine, the techniques of which are bestmastered after graduation, the aim is to discourage thegood student from the vain pursuit of a command of allavailable skills. To ensure, in addition, that no studentwill meet with a patient without being able promptly topass him through a systematic examination which willreveal any defect, the tutor system has been establishedin two of the hospitals associated with the school. Muchthought is being given to the problem of the student,who, in spite of ample time and adequate instruction,makes a mockery of the machine by failing to pass.Should he be discreetly disposed of, or should he beexhibited until he is overwhelmed by his- own ignominy ?

440 STUDENTS’ GUIDE 1955-56

COLONIAL SCHOOLS

Although higher education in the Colonies has a longhistory dating from the founding of Codrington Collegein Barbados in 1710, the publication of the reports ofthe Asquith Commission on Higher Education in theColonies and of its West Indies and West African com-mittees in June, 1945, has led to very rapid developmentduring the last ten years. In this post-war progress, fournew University Colleges have been created-the Univer-sity College of the West Indies, the University Collegeof the Gold Coast, University College, Ibadan, Nigeria,and the University College of Rhodesia and Nyasaland.In addition, Makerere College, Uganda, has been raisedto the status of the University College of East Africa,and the Gordon Memorial College, Khartoum, became aUniversity College affiliated to the University of London.Four of these University Colleges have medical schools.There follow short notes about these new enterprises andabout some of their older Colonial counterparts.

Ibadan

Few people have heard of Ibadan in Nigeria. Stillfewer know that during the past eight years a UniversityCollege has been created there, housed in 21/2 millionworth of striking modern buildings, or that an associatedteaching-hospital centre, costing over 31/2 million, is inan advanced state of construction. Having heard, theymay ask why.

Nigeria, four times the size of Great Britain, is thelargest remaining British Colonial territory and, with its32 million, the most populous part of Africa, with theexception of the Nile delta. It is very varied in race,language, culture, and terrain ; it is also, for the mostpart, very primitive. With its gradual development thedemand for trained men arose in all fields and was metby recruitment outside Nigeria and by the sending of asteady trickle of Nigerians to universities and collegesoverseas. But the supply has always been inadequate,and in few cases were establishments ever filled-a stateof affairs that still exists. Since the war the pace ofprogress has- increased, and there is a dearth of skilleverywhere. Although Europeans occupy many of thepositions of leadership and responsibility and will berequired for many years to come, recruitment is capriciousand the only solution is to train Nigerians and to trainthem in Nigeria. Moreover, in a country of such size,progressing rapidly towards independence, it is the onlyreasonable solution. Hence, the founding of UniversityCollege.The college has faculties of arts, science, agriculture,

and medicine, and provides courses and conducts exami-nations for degrees of the University of London. Thefaculty of medicine began in 1948. Since then the pre-clinical departments have prepared students for the2nd M.B. examination of the University of London, whichthey sit locally, with external examiners from Londonattending. The clinical departments have worked in twolocal hospitals, totalling 300 beds, which incidentally,provide medical care for the 600,000 people of Ibadan.Without such a foothold it would have been impossibleto have come to grips with the peculiarities of localmedical problems, to gain the confidence of the inhabi-tants, and to build up a hospital staff, medical, nursing,and administrative ; but it was soon clear that thesehospitals would never be suitable for clinical teaching. Anew hospital, specifically planned for teaching andresearch, had been included in the original scheme, butit was not until 1951 that funds were provided. Workbegan on a site of 185 acres in September, 1953. Many ofthe ancillary buildings have now been completed, theshell of the main fabric is well advanced, and the hospitalof 500 beds should be ready by the autumn of 1956.The teaching hospital, like the college itself, is an inde-pendent corporation, although deriving its entire revenuefrom the Nigerian Government. Already most of theadministrative organisation is in being and a nursing-training school, aiming at recognition by the GeneralNursing Council, has been in action for over two years.For the time being, with the cooperation of medicalschools in Britain, students who have completed theirpreclinical studies go to the United Kingdom for theclinical part of their training, pending the introduction ofclinical teaching at Ibadan.

Nigeria has few good secondary schools, and it is ahard struggle to reach the standard for entrance to thecollege. Although there are already signs that there islikely to be a sharp increase in the numbers of suitablestudents, up to the present 30 to 40 medical studentshave been admitted annually : in a sense, then, theIbadan medical student is a man in a million. Thestudents’ intellectual capacity is that of a similar groupanywhere ; their diligence is remarkable-indeed, it isoften excessive. The reasons for this lie in their back-ground. Very few are independent, in the sense that theirimmediate families pay for their education. Many areState scholars ; competition for scholarships is intenseand failure means the withdrawal of support. Others aresupported by family groups (the " extended family " ofthe anthropologist) or by tribal societies. These groupsexpect results and the student who has failed suffershumiliation and probably withdrawal of financial help.Small wonder that these circumstances tend to producean attitude of over-application.But the students are not held in perpetual thrall by

their books. They are very keen on all forms of sport.They play hockey, soccer, cricket, and tennis well andexcel particularly in field events. In 1954 a medicalstudent won the high jump at the Empire Games atVancouver, and another has twice been selected as

wicket-keeper for Nigeria. They are enthusiastic dancers,and great discussers and debaters. Societies spring intobeing, some ephemeral, others more durable, for thestudy and discussion of almost every topic under theAfrican sun. It may possibly be due to the missionaryeducation of many of the students from the South thatthey are enthusiastic churchgoers : the new Protestantchapel is well-filled on Sundays. A Roman Catholicchapel will soon be completed and although, in a countrynearly 50 % Muslim, there are relatively few Muslimstudents, a mosque is soon to be built.The college and the teaching hospital are bold and

costly ventures, but they have vast responsibilities. Fortheir function is to graft on to tropical West Africanstock the substance, atmosphere, and ethos of a univer-sity, with all which these connote. The graft, foreign anddelicate at first, has already taken soundly. Researchproceeds apace and, in time, a corpus of knowledge,indigenous and applicable to Africa, will emerge.

West IndiesThe past year marked the end of the first stage in the

development of the medical school of the UniversityCollege of the West Indies in Jamaica when its firstbatch of medical students graduated. In December,1954, 13 out of the 15 students who entered obtained theM.B., B.s. degree of the University of London. This hasacted as a great stimulus to West Indians to read medicineat their own medical school, and already less than 1 in 4who apply for entry can be accepted. Although thecurriculum is that of the University of London, thestudents have to cover considerably more ground thanequivalent students in Britain. They not only have tolearn enough to pass the London examination but also,and often in considerable detail, about local conditionsin the West Indies. Save for some industrial diseases,there are few conditions in Britain which are not alsomet with in the West Indies, although some of them(pernicious anaemia, for example) may be rare. On theother hand, there are many important conditions com-mon in the West Indies which receive scant mention inEnglish textbooks, such as sickle-cell anaemia, yaws,and lymphogranuloma venereum. The first medicalstudents started their premedical studies only in 1948and although entries to the medical school have increasedsince then, the proportion of both staff and beds tostudents is still considerably greater than in any medicalschool in Britain, and the majority of staff are full-time.Hence students get more individual attention and morepractical responsibility. The training does, in fact,approximate more closely to the apprentice system.A long-standing criticism of British medical schools

has been the tendency to " in-breeding " in the recruit-ment of staff. This cannot occur with a newly foundedmedical school and the policy of the college has beento get the best available man for the job, wherever hecomes from.