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respect our County Council as the education authority ofLondon still has much to learn.

To enumerate and to explain all the technical matters

with regard to which exchange of knowledge and experiencebetween London and Paris would be useful to both cities is a

task which would take much time to accomplish. It mightbe the subject-matter of a weighty volume and not a few

chapters of such a volume have already appeared as specialarticles or reports in these columns. For the moment we

are only desirous of emphasising the great benefits which are

likely to accrue to both cities if they will endeavour to

profit by each other’s experience when dealing with the

problems affecting the material welfare and health of theircitizens. With this end in view we feel the utmost gratifica-tion at the success of the visit and heartily congratulate allthose on both sides of the Channel who have contributed

to that success. And we may add a special word of con-gratulation to Sir EDWIN CORNWALL, chairman of the

London County Council, upon the honour of knighthoodwhich His MAJESTY has been pleased to confer upon him.

Medical Education in London.FOR those who have already passed from their medical

schools to the active sphere of professional life the openingof the October session inevitably recalls the date at whichwith varied emotions they first entered upon their careersas students. As an anniversary the date inevitablyengenders a thoughtful spirit which embraces the past, the

present, and the future. This spirit finds its expression inthe post-prandial speeches made whenever former students

foregather and in these it is mostly characterised byanecdotal reminiscences, ranging from the dissecting roomand the football field to the examination hall and the

personalities of past friends and teachers. The inauguraladdresses delivered to the new students supplement the

feeling that is abroad. The speakers here more often lookto the present and the future and, while the part of the

prophet is difficult, by careful study of the addresses thereis commonly much to be learnt of the general aims and hopesof the medical profession. We have already commented t

upon the general expression in the introductory addresses ofthe urgent need of moral and pecuniary support for theadvancement of medical science and it is with no desire

to weaken the conviction of that primary necessity that wereturn to a more detailed consideration of one of the

addresses-viz., that of Professor T. CLIFFORD ALLBUTT

at King’s College Hospital--whose words, though applicableprimarily to a London audience, conveyed a message of thefirst importance to all our readers. The Regius Professor ofPhysic at the University of Cambridge occupies a positionwhich lends peculiar force and interest to his remarks.

He can speak of medical education in London from the

point of view of one whose life is spent in the serener atmo-

sphere of an educational centre free from many of the

pressing anxieties of the metropolis, and free from the spiritof emulation and rivalry amongst the medical schools whichhas done much to hamper the development of the universityspirit, even though it may have been helpful in main-

taining a general high level of education. Professor

1 THE LANCET, Oct. 14th, 1905, p. 1117.

CLIFFORD ALLBUTT is not by any means in the positionof a detached observer, commenting upon matters of whichhe has no personal knowledge and in which his

interest is purely academic. A large number of the

medical students in London are members of the Uni-

versity of Cambridge and most of the Cambridge medicalstudents are passed under review in London as they presentthemselves for various examinations. In this way, there-

fore, if in no other, Professor CLIFFORD ALLBUTT has become

intimately acquainted with some of the results of medicaleducation in London and his remarks have the value of

those of a kindly and impartial critic. As all our readers

have had the address before them in full it is unnecessary

for us to point out that nowhere did Professor CLIFFORDALLBUTT display the spirit of the partisan, while every-where the polished diction and scholarly elegance which hehas taught us to expect from him were fully in evidence.

Amongst the initial defects in education, speaking broadlyof all forms of education, is the amount of time that mnstbe spent in acquiring the habit of study. This in many cases

cannot be helped, but over the number of facts that haveto be mastered those responsible for a given curriculum havediscretion. Professor CLIFFORD ALLBUTT appears to regard"facts" as being of minor importance and it is without

doubt true that for educational purposes examinations

and examiners frequently fail in their duty by attach-

ing too great importance to verbal accuracy (which mayoften be merely the result of cramming) while insufficientstress is laid upon practical work. This charge was formerlybrought against many of the examinations held in London,but there is abundant evidence at the higher examinationsof the London Conjoint Board and of the University of

London that clinical work is now held in greater estimationand that the man of book lore is being discouraged.Professor CUFFORD ALLBUTT considers that in edura-

tion the primary function of the teacher is to train,

the student to distinguish the important from the un-

important truths and to grasp quickly the fdcts which

matter,"-that is to say, that he considers that the first

thing which the student must learn is "the habit of study."When he has this the good sense of examiners must be

left to appreciate his memory of facts. In this connexion

in his address he referred sympathetically, in speakingof chemistry, to the enormous burden imposed upon the

memory of the medical student by the present systemof education and examination leading to a natural

tendency to dismiss a subject when once the goal hasbeen reached. "Receptiveness has its limits and the shipmust be lightened." Without doubt the modern student

of medicine has a hard task before him, but it is often

rendered needlessly hard by undue importance beingattached to each subject by each teacher, and by in-

sufficient attention to the interdependence of the different

parts of the medical curriculum. The earlier subjects inthe course of the training of the medical student have an

importance beyond affording opportunities of training habitsof observation, habits of study and manual dexterity;.they supply the necessary groundwork or foundation of

fact which is essential to the proper study of clinical

work. It is mainly for this reason, we believe, that.

so much thought has been expended in the separation of

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the earlier studies from the clinical work, and the presentdanger of medical education throughout the kingdom liesin the amount of time demanded for the earlier studies at

the expense of that devoted to clinical observation. It is

upon this subject that Professor CLIFFORD ALLBUTT’S

address is at the present moment peculiarly valuable. He

enumerates the complex divisions of clinical work which fallto this period of a student’s career, and it at once becomesevident that the last two academic years are wholly in-adequate to afford opportunity for obtaining more than amere smattering of them. Some of these subjects maybelong to what is now regarded as the earlier scientific

training but several of them can only be attended during theclinical period of study, to the manifest overcrowding of that

period. In practice it has been found that the whole of thefirst three years has been annexed by the teachers of theearlier scientific subjects and with the uncertainty of theresults of examinations students are fortunate, indeed, if atthe end of this period they are free to commence their

clinical work. And when they do so they find themselvesconfronted with more work than it is possible to get through,without great ability and considerable luck, in the statutoryperiod of their two remaining years. Professor CLIFFORD

ALLBUTT regards as possible an extension of the curriculumto six years, as in Germany, France, Italy, and other

continental countries, but pending such an alteration he

urges a revision of the curriculum to allow at least two and

a half years to be spent in clinical work. He also, perhapssomewhat to the astonishment of his audience, warmlyadvocated the one-portal system of qualification, though thiswas natural, as under such a system a certain amount oftime would certainly be saved.

It is at first sight curious, at a time when some of theLondon schools are resigning the giving of instruction in

the earlier scientific subjects and devoting themselves

purely to clinical work, to find Professor CLIFFORD

ALLBUTT raising his voice in favour of instruction in

country hospitals. He would seem to be in one voice

advocating consolidation and recommending the oppositecourse. But this is not so. The union of the London

hospitals will surely lead to arrangements for free inter-

change of students and in many cases it will tend to theinculcation of broader views and to weaken the spirit ofdogmatism which so often results from the present systemof separate centres. There would appear to be many diffi-

culties under any general scheme of amalgamation, amongstwhich it is only necessary to mention that of "signing up "

for attendance at lectures, and there would be some

loss of the personal relation between the teacher and

the student which has long been recognised to be

the chief advantage of the smaller schools. But

economy and efficiency seem to us to call for this

reform. With regard to the wards of a country hospital,we see no reason why they should not furnish valuable

material for clinical observation if the medical staffs can

make any arrangements for the reception of students, and ifit is understood that no new centres of education are beingstarted, but merely wayside stations provided along an

arduous track, whereat the traveller can obtain occasionalrefreshment. The limited time of the student is too preciousfor any part of it to be unproductive, and in the hospital

of a great city the constant variety in the medical and

surgical wards, as well as in the special departments, mustof necessity be greater. Throughout Professor CLIFFORD

ALLBUTT’S thoughtful address this was the only suggestionthe force of which we had some difficulty in appreciating andit only remains to conclude with a word of gratitude to

him for the valuable help which his words have rendered

in the solution of some of the problems which surround the

complex question of medical education in London.

Public Control and Public Healthin the County of London.

WE have received from the Clerk to the London CountyCouncil a report by Mr. ALFRED SPENCER, chief officer ofPublic Control, which gives particulars of the work of hisdepartment for the year ended March, 1905. This reportmay be regarded as supplementary to that of the medical

officer of health, inasmuch as it deals with several matters

affecting either directly or indirectly the health and well-

being of the dwellers in the metropolis. It opens with an

interesting section on coroners, giving particulars as to

the number of inquiries held in the several metropolitandistricts and as to the remuneration of coroners and

the costs of inquests. Useful and well-arranged tables

are given, showing, as regards the several cases in whichinquiry has taken place, the causes of death of the

deceased, their ages at death, and the ‘ findings " of thecoroners’ juries. The powers of the London County Councilwith reference to coroners differ considerably from thosepossessed by other local authorities. They consist chiefly inthe appointment of these officers and the payment of theirsalaries, the apportionment of their districts and the regula-tions and disbursement of costs connected with the holding of

inquests and last, but not least, in the provision of suitablecoroners’ courts, with convenient mortuary and post-mortemarrangements in connexion therewith. But in the judgmentof the County Council even the exceptional powers which it

possesses are inadequate for the administrative needs of the

metropolis. Accordingly, on several recent occasions the

Council has memorialised, hitherto unsuccessfully, the

Lord Chancellor and the Home Secretary, urging uponthem the desirability of amending the Coroners Acts.

The following are among the more important alterations

advocated by the County Council, the adoption of which,the Council believes, would lead to greater efficiency aswell as to economy in the discharge of the work of

the coroner’s court: (1) that no death should be regis-tered without attestation as to cause on a prescribedform, signed either by a medical practitioner after identi-fication of the body or by the coroner after inquiry,the certificate being sent to the local registrar and not

to the relatives of the deceased, as at present; (2) that

medical investigators should be appointed to inquire into

the causes of all uncertified deaths, to make post-mortemexaminations when necessary, and to act as medicalassessors to the coroner; and (3) that the number of

jurymen should be reduced to half their present statutoryminimum and that the " viewing of the body" by thejury should no longer be obligatory. The County Council