Læknablaðið - 01.06.1972, Blaðsíða 52

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LÆKNABLAÐIÐ
to fit himself for full responsibiiity in whatever field of medicine
he seeks to become established.
Many but not all of the medical schools in Britain were establish-
ed by the universities. Some of the earliest schools were in London
and were established independently at hospitals, which only later
became linked with the University of London. As a large proportion
of the British graduates received at least their clinical training in
London, this meant, that in much of its formative period, British
medical education was less subject to university influences than
were most other contemporary disciplines. This relative detachment
from the universities was even more marked in postgraduate than
undergraduate education. The first specifically designated postgraduate
school of London University was the London School of Hygiene and
Tropical Medicine originally established in University College, London.
and only separately established in its present premises as recently as
1928. Six years later a hospital, which had not previously been as-
sociated with teaching at Hammersmith, was designated as the Head-
quarters of the Postgraduate Medical School of London and many
of you know it and men such as John Goodwin and Bill Cleland
well. The Institute of Psychiatry and the Institute of Child
Health followed a little later and other establishments were develop-
ing at certain other specialist hospitals in London for the promotion
of training in other special disciplines. Apart from the School of
Hygiene these London institutes were all concerned with training in
one or other of the special fields of medicine, surgery or obstetrics
in hospital medical practice. Some of them had a long record of
leadership in the development of their specialties. They had originated,
some of them over 100 years ago, as hospitals in which specialists
with a primary interest in a particular field of medicine were able
to restrict their concern to that field alone and so to develop a special
expertise in it, when such specialisation was not welcomed in the
general teaching hospitals in which they also worked. Even such
departments as neurology, neurosurgery, cardiology and urology were
only developing within the general teaching hospitals in the 1930s.
Outside London somewhat similar progress occurred through the
establishment of special hospitals for instance for children’s diseases,
obstetrics and gynaecology, ophthalmology, ear nose and throat sur-
gery and orthopaedic surgery. However, the obsession with the general
medical or general surgical approach was less inhibiting in some of
the provincial centres. Nevertheless much training of specialists for
the future depended upon the aspirant serving as a junior to an
established specialist in a relationship that was essentially that of an
apprentice.
General practitioners were universally available throughout
Britain, but even 20 years ago there was no concept of orderly pre-
paration for general practice. It was assumed, especially by the hos-
pital specialists, that doctors turned aside into general practice not,
because their interest led them there but because they saw no way