947THE SESSION OF THE GENERAL MEDICAL COUNCIL.

THE LANCET.

LONDON: SATURDAY, DECEMBER 2. 1916.

The Session of the General MedicalCouncil.

THE General Medical Council began its secondsession of the year on Tuesday last, when SirDONALD MACALISTER, in his presidential address,summarised the position and activities of themedical profession in the critical present days.After referring to the losses which the medical

profession has sustained in personnel, family,substance, hopes, and prospects-matters which areall painfully familiar to our readers-he explainedwhat had been done up to now for maintainingthe supply of male medical students in training forcommissions in the Navy or Army. A census ofstudents in attendance on professional instructionin the schools of the United Kingdom, as submittedto the Army Council and an Emergency Committeeof the General Medical Council, shows the followinganalysis :-

Men. Women. Total.Men. Women. Total.

First-year students ... 1422 .... 636 ...... 2058Second-year students... 783 ...... 295 ...... 1078Third-year students... 519 ..... 163 ...... 682Fourth-year students... 1078 ...... 145 ...... 1223Final-year students ... 922 ...... 140 ...... 1062

Of these students, 500 of the juniors were under18 years of age in May, 1916, but all the otherswere above that age. The students in the fourthand final years have already been directed by theArmy Council to pursue their medical studies,so that the working of the Military Service Actis practically concerned with students in thesecond and third years. Sir DONALD MACALISTER

explained that he had called the attention of themilitary authorities to the danger of further deple-tion at this place. As a result, the Army Councilhas issued orders that registered medical studentsnot classed as " fit for general service " are to berelegated to the reserve, on condition that, whileleft to pursue their professional studies, they enrolthemselves in an Officers Training Corps. Onsimilar representations being made to the Admiralty,that Service, said Sir DONALD MACALISTER, recognisedthe importance of the problem to be solved, and, so faras existing conditions permit, both the War Officeand the Admiralty will attempt to adjust in a satis-factory manner the conflicting claims upon the youthof the nation who are intending to follow a medicalcareer.

The President of the General Medical Councilmade an important statement upon the supply ofqualified practitioners needed by our ever-growingForces, quoting a letter received at the opening ofthe Session from the War Office, in which thatdepartment said that they would gladly engage 400more medical Dractitioners to-morrow if they were

forthcoming." He explained the work which theCentral Committees now established in England andScotland had done for the purpose of assistingthe Government and the medical profession in

securing the proper allocation of the availablemen. As every medical practitioner of militaryage who is fit for service is liable to be called tothe combatant ranks, unless he receives a commis-sion as a medical officer in the Forces or is exemptedby one of the Central Committees, which are pro-fessional as well as statutory bodies, the respon-sible and delicate nature of the work of theseCommittees is evident, and in that work certainmembers of the General Medical Council have

played an active part. This is as it shouldbe, for the duties of the Central Committeesare twofold: they have to consider the respec-tive requirements of the Navy, the Army, and thecivilian population, and while deciding who can bespared from civil practice, they have also to con-sider schemes for the protection of the interestsof those whom, to a certain extent, they may beregarded as having recruited for active service.We published in THE LANCET of Nov. llth (p. 844)the procedure which is recommended by the CentralMedical War Committee for England and Walesas one under which the medical practitionersremaining behind could cooperate alike in carryingon the medical work of the country and in pro-tecting the interests of their absent colleagues;but the scheme needs for its success theassistance of the profession at large if it isto accomplish its objects in any substantial way.There can be no doubt that such universal

support has not been obtained. Letters whichhave appeared recently in the Times have suffi-

ciently showed that some members of the medicalprofession " have not," to quote Sir DONALDMACALISTER’S words, " yet realised the duty andprivilege of sharing the burdens of those whoare bearing so much for us....... If the voluntaryorganisation of the profession, which has attainedso gratifying a measure of success in this country,should by reason of their defection fail to meet allthe requirements of the medical services, we mayhave to face some form of legislative compulsionfor districts that are backward in their response tothe calls of patriotism." And he went on to informhis audience, or rather to warn the medical pro-fession at large, that the Council might obtainincreased disciplinary powers better to deal withcases where individuals were ascertained to be

defaulting from the duties imposed upon them bythe national emergency.In a third direction Sir DONALD MACALISTER

spoke words of grave counsel to the medical pro-fession. We have all become aware that in con-

nexion with the organisation of the resources ofthe nation for naval and military service for the

supply of munitions, and in regard to sick relief,pensions, insurance, and other circumstances oflife to-day, there has arisen a heavy demandon medical men for certificates, a demand whichis steadily increasing. The giving of these cer-tificates caused no inconsiderable trouble to themedical profession before the war, and that trouble

948 A GREAT NATIONAL SCHEME OF RESEARCH.

has now been multiplied almost indefinitely. Nodoubt Sir DONALD MACALISTER is sympathetic withthe general practitioner in this position, but asPresident of the General Medical Council he felt ithis duty to warn the profession that the issuing ofmedical certificates was their privilege, implying atrust on the part of the State in the registeredpractitioner, and the trust carries with it graveobligations. We agree with Sir DONALD MACALISTERthat as a whole these obligations have been faith-fully observed and that medical certificates havebeen issued, as a rule, with a due regard to truthand accuracy; but he informed the Council that

important Government departments had made

representations which showed that this sense of

responsibility had not been present in all cases ofmedical certification. He uttered grave words of

warning to those who may stand in need of them.Of such we trust that there are not many, butcharges of giving improper certificates are to beheard against practitioners this Session.

A Great National Scheme ofResearch.

A YEAR ago, when the Medical Research Com- mittee of the National Health Insurance publishedtheir first annual report, we analysed with some 1

particularity their activities, recording in detail ithe various departments of the work, what had l

been already done, and what the Committee 1

expected to do. The work of the Medical =Research Committee is now universally recognised; of the promised researches a large share has i

appeared in our own columns, and with this we may assume our readers’ familiarity. Of the four i

permanent departments, that of bacteriology has been closely associated with work on wound infections and their prevention, a large part ofwhich has passed into general surgical practice; that of biochemistry with the successful drug treat- ment of dysentery and bilharziosis; that of applied i

physiology with the solution of various problems i

concerning factory hygiene, poison gases, and trench foot; and the statistical department with (

the great business of army medical statistics. A jnew fifth department of clinical research has been t

added this year, under the general direction of (

Dr. THOMAS LEWIS, at the Mount Vernon Hospital, a building which, while remaining for the period of 1

the hostilities under the control of the War Office, ihas now become the formal property of the IResearch Committee. The personnel of the Com- imittee has changed owing to the statutory retire- Ement of three members, Lord MouLTON, Sir fCLIFFORD ALLBUTT, and Professor MATTHEW HAY, t

whose places have been filled by Lord GOSCHEN, tProfessor GEORGE MURRAY, and Dr. A. K. CHALMERS. The present report is signed by Major WALDORF (

ASTOR, who has become chairman, and by Dr. W. M. 13FLETCHER, the secretary of the committee. Lord 1

GOSCHEN has accepted the treasurership. iThe office work of the Committee now carried on t

at the Central Research Institute, 15, Buckingham- street, Strand, has been colossal. The Committee i

have been content with nothing less than obtaining f

a complete medical record of every man from thetime that he is wounded or taken ill at the frontuntil his final convalescence. During this time hiscase will have been recorded in the books of at leastsix different institutions, and the Committee at firstcarried out the task of extracting completely, bymeans of a small army of women clerks, the recordson the registers of some 2000 military hospitals.A uniform card system in each hospital has nowbeen designed to take the place of this thanklesstask, and the cards accumulated and sorted bythe department already weigh over 15 tons. The

expense of this work, although considerable, willbe far more than compensated by the valueof the consistent knowledge gained in connexionwith granting pensions and allowances, for recordscan never be too full or elaborate while they arekept rigidly sifted, and the abuses of idle accu-

mulation are avoided. Lack of such a contem-

porary record and the resulting impossibility ofdisputing fictitious claims is credited with havingcost the American Government many millions ofdollars at the conclusion of the Civil War, thoughthe sum we have heard mentioned seems to usfantastic. The card system now adopted, althoughdesigned to make possible a medical history of thewar complete in every particular, does not affordthe means of immediate ready reference: accord-ingly a schedule system of cards and envelopeshas been designed to obtain the current informa-tion which is urgently needed on such topics asabdominal wounds, amputations, trench nephritis,neurological cases, and the like. In addition tothe written records, the basis has also been formedof a national collection of army pathologicalspecimens at present housed at the Royal Collegeof Surgeons of England under the care of ProfessorARTHUR KEITH.

Most of the funds, as well as the scientificresources of the Committee, have been devoted tomedical questions of immediate national urgency inwar time. Certain pre-war work in connexion with

tuberculosis, rickets, the hygienic relations of milk,and other matters has continued, but in greatlydiminished proportion to the whole. The Committeejustify this diversion of National Insurance fundsto war problems by the statement that the solutionof these problems will remain for the whole futureof peace, and they have construed their labours in alarge spirit which will entail the remote, if not theimmediate, advantage of great bodies of insured

persons. Support has been given to an organisedinquiry into fatigue at factories and other medico-social problems, and the information gained hasformed the basis of action of the Health of Muni-tion Workers’ Committee in framing measures forthe material benefit of the vast army of munitionworkers. Arrangements have been made by theCommittee for the physiological testing of salvarsanand its similars of French and British origin. This

help not only meets a national need in founding anindispensable industry, but will materially assistthe recommendations of the Royal Commission onVenereal Diseases which are being carried outin the State-supported schemes all over the countryfor the control of these diseases. Surprise has