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Annotations.

THE SHORTAGE OF MEDICAL STUDENTS.

" Ne quid nimis."

WE published last week a letter from Sir. DonaldMacAlister in which he gave figures supplied. tohim from the various schools of medicine through-out the kingdom showing a marked falling off inthe number of medical students pursuing theircurriculum at the end of 1914 as- compared withthose undergoing education- at the correspondingdate in the preceding year. The President of theGeneral Medical Council pointed out that perhapsfrom 200 to 300 fewer practitioners would yearlybe, added to the medical profession for some

time-an average shortage of 25 per cent.-andthia is a serious matter, implying a numericalweakness in our body which will follow for a periodthe establishment of peace. The- extend of the

shortage and its duration are difficult, or impossible,to estimate, for the war now raging is without anyparallel in history from which we can form opinions.The war has absorbed, and is likely to absorb,so many young men who otherwise would be

undergoing training for various professions thateducation for the peaceful callings of civil man-hood, so far as able-bodied youths of military ageare concerned, is for the moment largely arrested.Indeed, a shortage of 25 per cent. in those pre-paring for admission to professional life might, weconceive, easily be exceeded in the case of otherprofessions. This is not surprising, for a supply ofmedical men is necessary to the health of the

country, while students who remain at the medicalschools now are helping in the conduct of the

struggle by their assistance in the hospitals.An anxious demand for the services of medical menand the expectation of high efficiency on their partwill probably be observable when peace renders itpossible to review the position and make disposi-tions for the maintenance of the health of thenation in the future. It will then be known towhat extent there is shortage, and to what extentthe law of supply and demand will give rise to

higher emoluments, and so to an increase in thenumber of those seeking medicine as a career. Ifa prophecy may be hazarded, it seems not im-

probable in the circumstances that the medicalprofession of the not distant future will offerbetter inducements to young men of abilitythan it has done hitherto, and that a raisedand well-sustained standard of efficiency will bethe result. In the meanwhile there is likely to bea certain shortage as there will be in all the pro-fessions, and the premature closing of’ manypromising young lives will make itself felt for

long years to come. There will be inconvenienceto the public, and a demand will make itself feltmore urgently than hitherto for the distributionof medical practitioners through the country ina more symmetrical manner, causing the shiftingof some who have chosen populous centres, wellsupplied already, to less attractive areas, wherethe need for their services is greater and wherethe competition of their colleagues is less keen,The advocates of a State Medical Service will seehere an opportunity. Its opponents will point tothe advantages of a free hand being left to thoseconcerned, subject only to such pressure as the lawof supply and demand may exert.

EDWARD ALANSON, A PIONEER OF SURGICAL

CLEANLINESS.

ONE of the most interesting consequences ofthe study of the history of medicine lies inthe adumbrations of modern principles and prac-tices which we are accustomed to regard as a

modern dayspring piercing the darknes-s of an

age of night. An interesting example of thisis given us by Mr. R. W. Murray in an accountof one whom he rightly describes as "one ofthe greatest surgeons Liverpool has ever pro-duced." 1 Edward Alanson, who flourished from1743 to 1823, went to Liverpool in 1763 to studymedicine as apprentice to Mr. Pickering, one of thesurgeons to the Liverpool Infirmary. On the com-pletion of his apprenticeship in 1768 Alansonwent to London, where for two, years he was a.

pupil of John Hunter, and returned to Liver--pool in 1770 to commence practice,, being electeda surgeon to the infirmary. The important factin regard to Alanson’s position as- a pioneerof modern surgical principles lies in his views.regarding the general treatment of patientsin hospitals, his suggestions for obviating thevitiated atmosphere, and his advocacy for sur-

gical cleanliness, as quoted at length by Mr.

Murray. Briefly summarised, it may be stated thathe urged that no ward should be occupied for morethan four months, but that then it should be

thoroughly cleansed, and the walls scraped andwhitewashed; that the bedding should be of suchmaterial (chaff and hay) as would permit ofits being frequently changed; that it should be

exposed to the air for four hours daily; thatinfected clothes and bedding should be bakedin an oven; that gangrenous or putrid woundsshould be isolated; that there should be openwindows in every ward ; that there must beno overcrowding, for which reason chronic,incurable, or infectious cases should not be

accepted; that convalescent homes should be estab-lished in connexion with infirmaries ; that par-ticular, airy rooms should be provided for operationcases, never be long inhabited, and should bealternately cleaned and ventilated; and that,all bedgear used in, "putrid cases" should becleansed and disinfected by baking. Alanson inhis own practice avoided ligaturing en masse

and cleansed the wound thoroughly with warmwater, all coagulum being carefully removed;and he always washed his hands thoroughlybefore operating, an unusual action in his day.As a result he was enabled to state that thoughhe had never refused to operate in any casewhere a single person in consultation had deemedan operation advisable, he had operated in theinfirmary in 35 cases promiscuously without asingle death, without a case of secondary haemor-rhage, and only one of exfoliation. When Listerstarted on his epoch-making career the con-

’ditions of hospital surgery were such that no-

general improvement could have taken place overthose found by Alanson prevailing in the infirmary.Lister clearly established by the enunciation andproof of the germ theory of disease the " how " ofthe connexion between dirt and disease in surgery,and thus principles which had been foreshadowedin vain by Alanson inevitably compelled generalacceptance under Lister.

1 Edward Alanson and His Times. By R. W. Murray, F.R.C.S.Liverpool: Samuel Hill and Sons. 1914. Pp. 26.