1070

Scientific, especially medical scientific, departmentsoften carry one or two men regarded as

"

passengers "

by their colleagues because they do no research or atleast publish none. I strongly suspect that a proportionof these men have got into academic medicine not

realising in the first place how far away it would takethem from the humanitarian side of their profession.They are inactive in research because of a reluctance tospecialise beyond a certain point which their generalmedical training disposes them to find the limit com-patible with a humanitarian, a7opposed to a scientific,outlook. Only in their teaching can they feel sure thatthey are doing something of definite value to society.The more widespread teaching of general medicine to

undergraduates would not only benefit the latter but

might also provide an outlet for doctors with an urge toteach without having to make a pretence at embracingsome specialty.

Holbeach, Lincolnshire. A. J. RICHARDS.

THEORY OF CEREBRAL LOCALISATION

W R,-I agree with Dr. Jefferson’s thesis (April 28)that the results of hemispherectomy call only for a

renewal of attention to already established, thoughrecently unemphasised, clinical and experimental observa-tions, rather than for any radical revision of theories ofcerebral localisation ; but the effects do not seem to meto argue against Jackson’s view that destructive lesionscause negative symptoms.The clinical and electrical evidence suggests that the

damaged hemisphere as a whole constitutes in Jacksonianterms a " discharging " quite as much as a

" destructive "lesion. The results of removal are essentially negative-namely, a reduction of abnormal discharge. Thebeneficial effect on the remaining cerebral economyreflects the extent of the abnormal discharge removed.Although, apart from the visual sphere, the evidencedoes not as yet reveal any clear loss of

" normal func-tion, I would hazard a guess that further study willenable us to see something of that too : though it mayweigh very light in the balance of over-all benefit to thepatient.

Oxford. C. W. M. WHITTY.

SIZE OF MEDICAL SCHOOLS AND HOSPITALS

SiR,-I was interested in the letter from " Calculusin your issue of April 21.

I took my 1st M.B. work at Toronto University, in aclass of 150 students. Since then I have been at theMiddlesex Hospital in London, where classes have

averaged 45.At Toronto two shifts of 75 students were formed for

practical classes. These were each attended by therespective professors, assisted by three demonstrators.In the physics and chemistry departments practicalbooks were handed in for examination once weekly, andwere verbally corrected at the next class. In biology thelast fifteen minutes of each three-hour session was spentin a more or less informal viva from professor or demon-strator (working in rotation through the whole class),for which marks were assigned, these marks being con-sidered when assessing the students’ examination resultsin the first-year final examinations. Furthermore the

chemistry professor within the first six weeks of theautumn term could accurately fit name to face of all ofthe 150 students. This was achieved by assigning toeach student a numbered seat in the lecture-theatre,and the professor having on his desk a plan of the seatswith the students’ names entered on it. Also, if anystudent missed a lecture in a subsequent practical periodthe professor saw to it that that student understoodthe substance of the lecture that he had missed.

In physiology I had the good fortune to be taughtby Prof. Samson Wright and Dr. (now Professor) D.

Slome. Physiology, as taught by them, was not isolatedstudies of nervous system, circulation, digestion, &e.Each field was discussed in relation to the others; andthrough all, by a rapid-fire question-and-answer technique,we were taught to think rationally and for ourselves.

These experiences lead me to conclude that the complexgraphs and statistics mentioned by

" Calculus," of whichI have even less understanding than he, are not the onlyfactors in deciding how a big medical school ought to be.Good teachers are essential, and come before problemsof capital outlay, running-costs, and so on. It is nottrue -that a personal relationship cannot be establishedin large classes or that two people cannot adequatelyteach physiology, when first-class teachers willing towork at their job, can be found.London, N.W.3 ROY MOTTRAM.

HYPERCALCÆMIC URÆMIA WITHNEPHROCALCINOSIS

SIR,-The interesting case recorded by Dr. Fultonand Dr. Paget (April 21) is surpassed by one describedby Albright.l This was of a man of 50 who had a singlemetastasis of the right ilium and sacrum from a " hyper-nephroma " of the kidney, associated with hypercalcaemia,and hypercalcuria. The interesting part of the story isthat the serum and urinary calcium values went backto normal when the metastasis was irradiated, only tarise again when the condition relapsed.

Dr. Fulton and Dr. Paget suggest that " the syndromeonly develops in cases in which the bony secondaries areof sufficiently wide distribution or long duration." Thiscannot be, as in Albright’s case they were not widelydistributed; and their comparatively rapid responseto irradiation with subsequent relapse shows that longduration is not important. It is probably all a questionof how quickly bone is being destroyed.

Department of Pathology,University of Bristol. OLIVER C. LLOYD.

FOOD AND ENERGY

biR,—it is now some centuries since the scientic

method of observation and experiment replaced authori-tarianism, but I sometimes wonder whether the replace-ment was complete or whether the wheel is turning fullcircle. For we continually meet with statements made,or uncritically quoted, by men of authority which, whensubjected to scientific criticism, turn out to be no morethan expressions of opinion. When such statements ofa technical nature are made by people not skilled in therelevant branch of technology there is at least the excuseof ignorance, but it ill becomes the expert to lend hisauthority by quotation which implies tacit approval.

In his letter of March 10 Dr. Franklin Bicknell, possiblywith caution but certainly with subtle emphasis, quotedwithout comment from the report of the ProductivityTeam on Rigid Boxes and Cartons to the effect that dietplays an important part in enabling the American workerto work faster and to sustain the effort. Dr. Bicknell,with an accuracy which is unusual in such quotations,gave the entire relevant section of the report. Thereis nothing in the report to substantiate this surprisingclaim, which turns out to be a statement of opinion, ifnot of prejudice, and not of fact.The only piece of what might purport to be evidence

is that members of the productivity team were able towork all day without fatigue. While the layman mightbe excused for putting this down to the first cause

that comes to mind-namely, food-Dr. Bicknell mustsurely agree that change of environment, change ofworking conditions, intellectual stimulus, new interests,to mention but a few, might equally be responsible forthe absence of fatigue.London, W.13. A. E. BENDER.

1. Albright, F., Reifenstein, E. C. Parathyroid Glands and MetabolicBone Disease. London, 1948.