1300 cxsarean-section rate for fetal distress in primigravidae after 1972 and a slight decrease for that in multigravidae but these differences were not statistically significant.
Teaching and Research THE UNIVERSITIES AND MEDICAL
DISCUSSION
RESEARCH* This study gives an estimate of the effect of continuous intrapartum monitoring on our obstetric population. It cannot be said to "prove" that monitoring reduced labour-related deaths. Firstly, the study design, whereby one block of years is compared with a subsequent block is not ideal but, fortunately, in Aberdeen the population is relatively stable, all women deliver in the same hospital, and the transition from no monitoring to widespread monitoring when clinically indicated was very abrupt. Secondly, some of the important differences did not reach statistical significance. However, although the incidence of labour-related death remained unchanged for the 9 yr before introduction of intrapartum monitoring, there was a reduction in these deaths from about 2/1000 to less than 1/1000 exactly coincident with the introduction of monitoring and this reduction was due mainly to a drop in proportion of deaths due to asphyxia. In our opinion no other change in obstetric practice or in the population studied can explain this.
ANDREW WATT KAY
University Department of Surgery, Western Infirmary, Glasgow G11 6NT THE universities and medical scientists have many
responsibilities, and one of these is to society. Before the early years of this century their patrons were usually kings or merchant princes. Today in Britain they are obliged to accept block grants from the Treasury, and it is thus the man in the street who is now the patron of learning and of science, and who is in a position to exercise the despotism of the majority. That he has not yet done so is due, in large measure, to the protective role of the University Grants Committee and of the Research Councils. Academics and medical scientists must however accept the criticisms implicit in such commonly used phrases as "ivory towers", the "faceless men of science", and "coldly scientific", and they must be prepared to explain their ideas, their work, and their contributions to society. As far as medical research is concerned, the Rothschild proposals and the subsequent white-paper2 may well have been ill-timed. It would have made more sense to call for a review of the whole compass of the health sciences and on the basis of this review to plan an organisation capable of meeting agreed objectives, and of giving equal weight to, and allowing fullest interchange between, the three arms of medical researchbiomedical research, clinical research, and health-services research. We might then have been more ready to rebut accusations from the public about the scientists’ lack of social responsibility.
change in 1-min Apgar scores supports this and probably indicates a reduction in morbidity finding as well as in mortality. It is not possible to claim from this study, however, that mental abnormality and handicap have been reduced by monitoring. Coesarean-section rates were not altered by monitoring. The
Alternative study designs will not be satisfactory either. A randomised trial does not give an assessment of the effect of continuous monitoring in routine practice, and extremely large numbers would be required for statistical significance if labour-related death is taken as the end point. A comparison between monitored and non-monitored patients delivered during a given interval inevitably means that different populations are being
compared.
THE CHALLENGE TO THE UNIVERSITIES
Around every Senate table sit men for whom the word "university" stands for something different: for some it means a leisurely attitude to scholarship, exemption from the obligation to use knowledge for practical ends, and an opportunity to give undivided loyalty to the kingdom of the mind; for others it is an institution with essential obligations to modern society and a place which society regards as a pacemaker for scientific research and technological progress. Of course, both groups have right on their side but universities must search for a compromise. As the Faculty of Medicine has no option but to be involved in practice and in research in relation to the individual and the community, it can be foremost in declaring a university’s involvement.
The classification system we used3 allows identification of all babies dying during or as a result of labour, excluding babies with serious congenital abnormalities. Where attributing a cause of death is concerned, it is not of critical importance whether the baby is stillborn or dies within minutes, having gasped or had a palpable heart-beat. Similarly if there is a traumatic delivery with tentorial tear and cerebral haemorrhage this is the cause of death regardless of when the death occurs.
Labour-related deaths are infrequent and the percentage of babies whose lives will be saved by continuous monitoring is small-perhaps one baby in every thousand deliveries. Nevertheless, since these babies are usually mature, otherwise healthy, babies it is important to prevent these deaths.
The Tenure System ,
REFERENCES 1. Edington, P. 2. Thomson, A. monw.
T., Sibanda, J., Beard, T. W. Br. med J. 1975, iii, 341 M., Billewicz, W. Z., Hytten, F. E. J. Obstet Gynœc. Br. Com-
1968, 75, 903.
3. Johnstone, F. D. Unpublished.
The history of medical science records that truly original ideas-the forward leaps-have come from comparatively young men: the green years were yet upon the *Extracted from the Sir John Fraser memorial lecture Andrew in Edinburgh on Feb. 14, 1978.
given by
Sir
1301 heads of Harvey, Hunter, Lister, and Koch when they made their epoch-making studies. It is surely time for the cherished tenure system in universities to be exposed to the clear light of realistic scrutiny. Senior academic appointments are usually ad vitam aut culpam; if academics and scientists do not give some thought to means of introducing flexibility and improved incentives, into the academic career structure, then someone else will; alternatively, research of quality may atrophy.
troyed by resisting pressure to change and so losing its viability; and it could also have been destroyed by yielding too readily to change and thereby losing its integrity. There are some areas in which we should be determined to swim against the tide of popular opinion, though we must also be willing to explain the reasons for our failure to comply. This will require delicate diplomacy if we are not to lose the confidence and support of our
patrons. Universities are Nationallnstitutions
Collaboration
studying living organisms we may make the approach at the level of populations, or of individuals, or of tissues, or of cells, or of molecules; but we can claim few laurels for full exchange of information, good In
communication, and effective collaboration when this is called for. Almost every M.R.C. review of a research field in recent years has called for multidisciplinary research and indicated that the university with its medical school is the ideal environment; in theory this is unquestionably so, but we have a responsibility to see that it works in practice. This need is especially urgent in relation to health services research. Academics of varying disciplines must appreciate now that important knowledge can be derived from the study of human beings in large groups and that there are questions which can be answered only by the study of populations under controlled circumstances. For example, we must ask ourselves what is the total problem of coronaryartery disease in our society, what are the benefits to be expected. Awareness of this should be growing within universities so that enthusiasm can be engendered within our undergraduate medical schools. TheAcademic "Grand National"
University and M.R.C. units are experiencing difficulty in attracting medical graduates to careers in medical research, and the reasons are not difficult to find. Departure from the clincial arena entails the loss of substantial "overtime payments". In addition, the programmes laid down by Joint Committees for Higher Training for accreditation in the different clinical specialities (leading, almost invariably, to a consultant appointment) are rather inflexible, by the time the requirements have been satisfied, youth has almost gone and original thinking has been stultified. Nor can clinical and paraclinical professors escape censure: we are and we represented on specialist training committees make yet more demands on our young colleagues. The paper qualifications gained by passing the various hurdles which we have placed along the path of intellectual development (the academic Grand National)3 is an educational neurosis which is becoming more florid in its manifestations. I now subscribe to the view that a steady production of high quality scientific publications is a better reflection of an individual’s original research capabilities than is a string of letters after his name which reflects, in many instances, industry rather than originality. -
POSITIONS TO BE DEFENDED
The institution which we call a university has endured now for seven centuries. It could have been des-
of last year proposals were made in amendthe Labour Party’s final consultative document for local-government reform suggesting that universities and the National Health Service should come under local-authority control. These proposals were approved by Labour’s National Executive Committee for incorporation in the final executive statement which will be prepared for the party conference this year. As far as universities are concerned, the options include putting them under the direct control of the district authorities, or of the regional authorities, or in a partnership between national Government and the regional authorities. Those of us in the universities or involved in research related to the care of patients cannot accept any of these options and must resist them. Universities are national institutions, drawing their students from all over the country and from overseas. The Committee of Vice Chancellors and Principals has declared its opposition to the proposals including, in addition, the devolution of the Scottish universities. In
August
ments to
Insistence on Academic Freedom Universities and scientific research are financially dependent on the State and their support, without a basis either in law or in custom, thus rests almost entirely on the goodwill of those in power. We must be on the alert, responsive when required, and try whenever possible to’speak with a united voice; co-operative thinking and planning are essential, and where better to start than in Scotland. We have taken the first tentative steps through conferences of Faculties and of Courts and through meetings of deans and so on, but there is much more that can be done together, and more that we can learn from one another. A current opportunity has been the presentation of the S.H.A.R.E. report4 which, although primarily designed to provide a formula for the allocation of finance to the various area health boards in Scotland, carried important implications for universities with medical schools. The Universities of Aberdeen, Dundee, Edinburgh, and Glasgow were each invited to comment but, because of the influence of this new formula differed for each medical centre, it seems -likely that the responses showed little consensus, and so may have weakened the case for greater support for our teaching hospitals and for medical research in Scotland. Protection of
Fundamental Research The Rothschild reorganisation of Government research and development has perhaps ensured a moderate degree of health for the applied side of things but, with a static total budget, this has perhaps been too subtle
to
swing
have caused much individual comment. Yet the away from basic research must be halted before
1302 irreversible damage is done. Few scientists would need to be reminded of one good argument for supporting basic research namely, that you can never tell what it will turn up, and the occasional discovery such as Newton’s ’laws or Mendel’s peas can be infinitely more valuable -
in the long run than any amount of targeted investigation. But there are two other arguments which we in the universities should proclaim more frequently: that the support of fundamental research is a cultural activity which Government ought to have a genuine pride in fostering ; and that science and scientists recognise no national frontiers, so if support wanes in one country while waxing in others, British research workers will first have to depend more and more on the generosity of their foreign colleagues, and ultimately will themselves depart, or recommend their students to move to more
fertile pastures.
CONCLUSION
The universities are perhaps the most potent instrufor medical research. The greater part of our nonindustrial medical research is conducted in university departments. Increasing sophistication of research techniques, and the need to involve the expertise of a variety of disciplines in an attack on major health problems, means that research must frequently be undertaken in and an environment where these disciplines coexist the universities alone fulfil this requirement. Furthermore the universities have an important role in training scientists, thereby maintaining the nation’s research capabilities. Human health and happiness can only benefit from the hunt after truth and from its discovery; the academic, the scientist, is a benefactor of mankind whose often eccentric, idiosyncratic, and costly labours must continue to be underwritten by the body politic. ment
-
REFERENCES
Equilibrium between Research and Teaching One of the most important tasks for a university principal is to balance the conflicting claims of research and teaching. In this time of acute financial stringency, the universities have had to reconcile themselves to acceptan increase in the intake of undergraduate students in the absense of additional funding; teaching time has had to take precedence over research time, and this shift in emphasis has been exaggerated by the freezing of staff vacancies. Herein lies a further threat to the research base in our universities which must be counteracted if enough health research of merit is to survive through the pressures of the next decade. Teaching and research should be complimentary activities, but the time has come for consideration to be given to separate teaching and research funding to our universities.
ing
’
Retention
of Centres of Excellence There has been growing criticism in recent years about the concept of centres of excellence, based on the call for uniformity and equal opportunity. I believe that there is a continuing need for a number of institutions in each country which enable first-class representatives of the various disciplines to work together, and that the ideal environment is within a university. Scientists who have gone down the brain drain to the U.S.A., or elsewhere, claim that science is supranational and that it matters little where they make their discoveries so long as they are able to work and live under optimal conditions, financial and otherwise. Surely, however, it would be deplorable if the opportunities to make top-level discoveries in science were to become the prerogative of those working in Massachusetts or California? This possibility is reflected to some extent in the European chauvinism which has led perhaps with some justification to the establishment of EMBO (European Molecular Biology Organisation), which encourages a concentration of top-level researchers into a major global centre. Further movement in this direction would inevitably weaken our universities and lead to falling standards in teaching, training, and research in centres such as Edin-
-
burgh centres
and Glasgow. We of excellence.
must
be
sure we
have
enough
1. A Framework for Government Research and Development. Cmnd. 4814 H.M. Stationery Office, 1971. 2. Framework for Government Research and Development. Cmnd. 5046 H.M. Stationery Office, 1972. 3. Peart, W. S. Lecture to mark the 25th anniversary of the foundation of the Glaxo Volume; Glaxo Volume 38 (edited by G. Lilley). 4. S.H.A.R.E. Report (Scottish Health Authorities Revenue Equalisation) H.M. Stationery Office, Edinburgh, 1977.
Before Our Time
LOOKING BACK AT BAKER IN 1877, William Morrant Baker published a paper entitled "Formation of synovial cysts in the leg in connection with disease of the knee-joint". He is now chiefly remembered as the chronicler of the eponymous cyst, but he was much more than that. After qualifying at St. Bartholomew’s Hospital in 1861, Morrant Baker lectured on physiology at the medical school; Kirkes Handbook of Physiology, which he edited, was known to the students as "Baker’s book". At the same time, he had charge of the skin department and first described erysipeloid. When elected full surgeon to St. Bartholomew’s Hospital in 1882, working before the introduction of aseptic surgery, Morrant Baker did much of the original work on neuropathic joints and devised a new technique for removal of the tongue with an ecraseur. To orthopaedics he contributed a method of arthrodesis of the knee-joint, and he reported some remarkable blood-vessel surgery, including ligatures of great vessels. In one case, he successfully produced clotting in a femoral aneurysm by employing a series of medical students to maintain continuous pressure on the artery. Morrant Baker was associated with the founding of the Evelina Children’s Hospital, where he devised the first red indiarubber tracheotomy tube, and invented the duplex-burner reading lamp. He died aged only 57, in 1896, from locomotor ataxia-ironically, a disease he had studied extensively. This remarkable man encompassed all the surgery of his time, tackling many problems to which only increased specialisation and sophisticated technology have eventually produced solutions. St. Bartholomew’s Hospital, London EC1A 7BE
M.
J.
HERSHMAN
Medical Student
Teaching and Research THE UNIVERSITIES AND MEDICAL
DISCUSSION
RESEARCH* This study gives an estimate of the effect of continuous intrapartum monitoring on our obstetric population. It cannot be said to "prove" that monitoring reduced labour-related deaths. Firstly, the study design, whereby one block of years is compared with a subsequent block is not ideal but, fortunately, in Aberdeen the population is relatively stable, all women deliver in the same hospital, and the transition from no monitoring to widespread monitoring when clinically indicated was very abrupt. Secondly, some of the important differences did not reach statistical significance. However, although the incidence of labour-related death remained unchanged for the 9 yr before introduction of intrapartum monitoring, there was a reduction in these deaths from about 2/1000 to less than 1/1000 exactly coincident with the introduction of monitoring and this reduction was due mainly to a drop in proportion of deaths due to asphyxia. In our opinion no other change in obstetric practice or in the population studied can explain this.
ANDREW WATT KAY
University Department of Surgery, Western Infirmary, Glasgow G11 6NT THE universities and medical scientists have many
responsibilities, and one of these is to society. Before the early years of this century their patrons were usually kings or merchant princes. Today in Britain they are obliged to accept block grants from the Treasury, and it is thus the man in the street who is now the patron of learning and of science, and who is in a position to exercise the despotism of the majority. That he has not yet done so is due, in large measure, to the protective role of the University Grants Committee and of the Research Councils. Academics and medical scientists must however accept the criticisms implicit in such commonly used phrases as "ivory towers", the "faceless men of science", and "coldly scientific", and they must be prepared to explain their ideas, their work, and their contributions to society. As far as medical research is concerned, the Rothschild proposals and the subsequent white-paper2 may well have been ill-timed. It would have made more sense to call for a review of the whole compass of the health sciences and on the basis of this review to plan an organisation capable of meeting agreed objectives, and of giving equal weight to, and allowing fullest interchange between, the three arms of medical researchbiomedical research, clinical research, and health-services research. We might then have been more ready to rebut accusations from the public about the scientists’ lack of social responsibility.
change in 1-min Apgar scores supports this and probably indicates a reduction in morbidity finding as well as in mortality. It is not possible to claim from this study, however, that mental abnormality and handicap have been reduced by monitoring. Coesarean-section rates were not altered by monitoring. The
Alternative study designs will not be satisfactory either. A randomised trial does not give an assessment of the effect of continuous monitoring in routine practice, and extremely large numbers would be required for statistical significance if labour-related death is taken as the end point. A comparison between monitored and non-monitored patients delivered during a given interval inevitably means that different populations are being
compared.
THE CHALLENGE TO THE UNIVERSITIES
Around every Senate table sit men for whom the word "university" stands for something different: for some it means a leisurely attitude to scholarship, exemption from the obligation to use knowledge for practical ends, and an opportunity to give undivided loyalty to the kingdom of the mind; for others it is an institution with essential obligations to modern society and a place which society regards as a pacemaker for scientific research and technological progress. Of course, both groups have right on their side but universities must search for a compromise. As the Faculty of Medicine has no option but to be involved in practice and in research in relation to the individual and the community, it can be foremost in declaring a university’s involvement.
The classification system we used3 allows identification of all babies dying during or as a result of labour, excluding babies with serious congenital abnormalities. Where attributing a cause of death is concerned, it is not of critical importance whether the baby is stillborn or dies within minutes, having gasped or had a palpable heart-beat. Similarly if there is a traumatic delivery with tentorial tear and cerebral haemorrhage this is the cause of death regardless of when the death occurs.
Labour-related deaths are infrequent and the percentage of babies whose lives will be saved by continuous monitoring is small-perhaps one baby in every thousand deliveries. Nevertheless, since these babies are usually mature, otherwise healthy, babies it is important to prevent these deaths.
The Tenure System ,
REFERENCES 1. Edington, P. 2. Thomson, A. monw.
T., Sibanda, J., Beard, T. W. Br. med J. 1975, iii, 341 M., Billewicz, W. Z., Hytten, F. E. J. Obstet Gynœc. Br. Com-
1968, 75, 903.
3. Johnstone, F. D. Unpublished.
The history of medical science records that truly original ideas-the forward leaps-have come from comparatively young men: the green years were yet upon the *Extracted from the Sir John Fraser memorial lecture Andrew in Edinburgh on Feb. 14, 1978.
given by
Sir
1301 heads of Harvey, Hunter, Lister, and Koch when they made their epoch-making studies. It is surely time for the cherished tenure system in universities to be exposed to the clear light of realistic scrutiny. Senior academic appointments are usually ad vitam aut culpam; if academics and scientists do not give some thought to means of introducing flexibility and improved incentives, into the academic career structure, then someone else will; alternatively, research of quality may atrophy.
troyed by resisting pressure to change and so losing its viability; and it could also have been destroyed by yielding too readily to change and thereby losing its integrity. There are some areas in which we should be determined to swim against the tide of popular opinion, though we must also be willing to explain the reasons for our failure to comply. This will require delicate diplomacy if we are not to lose the confidence and support of our
patrons. Universities are Nationallnstitutions
Collaboration
studying living organisms we may make the approach at the level of populations, or of individuals, or of tissues, or of cells, or of molecules; but we can claim few laurels for full exchange of information, good In
communication, and effective collaboration when this is called for. Almost every M.R.C. review of a research field in recent years has called for multidisciplinary research and indicated that the university with its medical school is the ideal environment; in theory this is unquestionably so, but we have a responsibility to see that it works in practice. This need is especially urgent in relation to health services research. Academics of varying disciplines must appreciate now that important knowledge can be derived from the study of human beings in large groups and that there are questions which can be answered only by the study of populations under controlled circumstances. For example, we must ask ourselves what is the total problem of coronaryartery disease in our society, what are the benefits to be expected. Awareness of this should be growing within universities so that enthusiasm can be engendered within our undergraduate medical schools. TheAcademic "Grand National"
University and M.R.C. units are experiencing difficulty in attracting medical graduates to careers in medical research, and the reasons are not difficult to find. Departure from the clincial arena entails the loss of substantial "overtime payments". In addition, the programmes laid down by Joint Committees for Higher Training for accreditation in the different clinical specialities (leading, almost invariably, to a consultant appointment) are rather inflexible, by the time the requirements have been satisfied, youth has almost gone and original thinking has been stultified. Nor can clinical and paraclinical professors escape censure: we are and we represented on specialist training committees make yet more demands on our young colleagues. The paper qualifications gained by passing the various hurdles which we have placed along the path of intellectual development (the academic Grand National)3 is an educational neurosis which is becoming more florid in its manifestations. I now subscribe to the view that a steady production of high quality scientific publications is a better reflection of an individual’s original research capabilities than is a string of letters after his name which reflects, in many instances, industry rather than originality. -
POSITIONS TO BE DEFENDED
The institution which we call a university has endured now for seven centuries. It could have been des-
of last year proposals were made in amendthe Labour Party’s final consultative document for local-government reform suggesting that universities and the National Health Service should come under local-authority control. These proposals were approved by Labour’s National Executive Committee for incorporation in the final executive statement which will be prepared for the party conference this year. As far as universities are concerned, the options include putting them under the direct control of the district authorities, or of the regional authorities, or in a partnership between national Government and the regional authorities. Those of us in the universities or involved in research related to the care of patients cannot accept any of these options and must resist them. Universities are national institutions, drawing their students from all over the country and from overseas. The Committee of Vice Chancellors and Principals has declared its opposition to the proposals including, in addition, the devolution of the Scottish universities. In
August
ments to
Insistence on Academic Freedom Universities and scientific research are financially dependent on the State and their support, without a basis either in law or in custom, thus rests almost entirely on the goodwill of those in power. We must be on the alert, responsive when required, and try whenever possible to’speak with a united voice; co-operative thinking and planning are essential, and where better to start than in Scotland. We have taken the first tentative steps through conferences of Faculties and of Courts and through meetings of deans and so on, but there is much more that can be done together, and more that we can learn from one another. A current opportunity has been the presentation of the S.H.A.R.E. report4 which, although primarily designed to provide a formula for the allocation of finance to the various area health boards in Scotland, carried important implications for universities with medical schools. The Universities of Aberdeen, Dundee, Edinburgh, and Glasgow were each invited to comment but, because of the influence of this new formula differed for each medical centre, it seems -likely that the responses showed little consensus, and so may have weakened the case for greater support for our teaching hospitals and for medical research in Scotland. Protection of
Fundamental Research The Rothschild reorganisation of Government research and development has perhaps ensured a moderate degree of health for the applied side of things but, with a static total budget, this has perhaps been too subtle
to
swing
have caused much individual comment. Yet the away from basic research must be halted before
1302 irreversible damage is done. Few scientists would need to be reminded of one good argument for supporting basic research namely, that you can never tell what it will turn up, and the occasional discovery such as Newton’s ’laws or Mendel’s peas can be infinitely more valuable -
in the long run than any amount of targeted investigation. But there are two other arguments which we in the universities should proclaim more frequently: that the support of fundamental research is a cultural activity which Government ought to have a genuine pride in fostering ; and that science and scientists recognise no national frontiers, so if support wanes in one country while waxing in others, British research workers will first have to depend more and more on the generosity of their foreign colleagues, and ultimately will themselves depart, or recommend their students to move to more
fertile pastures.
CONCLUSION
The universities are perhaps the most potent instrufor medical research. The greater part of our nonindustrial medical research is conducted in university departments. Increasing sophistication of research techniques, and the need to involve the expertise of a variety of disciplines in an attack on major health problems, means that research must frequently be undertaken in and an environment where these disciplines coexist the universities alone fulfil this requirement. Furthermore the universities have an important role in training scientists, thereby maintaining the nation’s research capabilities. Human health and happiness can only benefit from the hunt after truth and from its discovery; the academic, the scientist, is a benefactor of mankind whose often eccentric, idiosyncratic, and costly labours must continue to be underwritten by the body politic. ment
-
REFERENCES
Equilibrium between Research and Teaching One of the most important tasks for a university principal is to balance the conflicting claims of research and teaching. In this time of acute financial stringency, the universities have had to reconcile themselves to acceptan increase in the intake of undergraduate students in the absense of additional funding; teaching time has had to take precedence over research time, and this shift in emphasis has been exaggerated by the freezing of staff vacancies. Herein lies a further threat to the research base in our universities which must be counteracted if enough health research of merit is to survive through the pressures of the next decade. Teaching and research should be complimentary activities, but the time has come for consideration to be given to separate teaching and research funding to our universities.
ing
’
Retention
of Centres of Excellence There has been growing criticism in recent years about the concept of centres of excellence, based on the call for uniformity and equal opportunity. I believe that there is a continuing need for a number of institutions in each country which enable first-class representatives of the various disciplines to work together, and that the ideal environment is within a university. Scientists who have gone down the brain drain to the U.S.A., or elsewhere, claim that science is supranational and that it matters little where they make their discoveries so long as they are able to work and live under optimal conditions, financial and otherwise. Surely, however, it would be deplorable if the opportunities to make top-level discoveries in science were to become the prerogative of those working in Massachusetts or California? This possibility is reflected to some extent in the European chauvinism which has led perhaps with some justification to the establishment of EMBO (European Molecular Biology Organisation), which encourages a concentration of top-level researchers into a major global centre. Further movement in this direction would inevitably weaken our universities and lead to falling standards in teaching, training, and research in centres such as Edin-
-
burgh centres
and Glasgow. We of excellence.
must
be
sure we
have
enough
1. A Framework for Government Research and Development. Cmnd. 4814 H.M. Stationery Office, 1971. 2. Framework for Government Research and Development. Cmnd. 5046 H.M. Stationery Office, 1972. 3. Peart, W. S. Lecture to mark the 25th anniversary of the foundation of the Glaxo Volume; Glaxo Volume 38 (edited by G. Lilley). 4. S.H.A.R.E. Report (Scottish Health Authorities Revenue Equalisation) H.M. Stationery Office, Edinburgh, 1977.
Before Our Time
LOOKING BACK AT BAKER IN 1877, William Morrant Baker published a paper entitled "Formation of synovial cysts in the leg in connection with disease of the knee-joint". He is now chiefly remembered as the chronicler of the eponymous cyst, but he was much more than that. After qualifying at St. Bartholomew’s Hospital in 1861, Morrant Baker lectured on physiology at the medical school; Kirkes Handbook of Physiology, which he edited, was known to the students as "Baker’s book". At the same time, he had charge of the skin department and first described erysipeloid. When elected full surgeon to St. Bartholomew’s Hospital in 1882, working before the introduction of aseptic surgery, Morrant Baker did much of the original work on neuropathic joints and devised a new technique for removal of the tongue with an ecraseur. To orthopaedics he contributed a method of arthrodesis of the knee-joint, and he reported some remarkable blood-vessel surgery, including ligatures of great vessels. In one case, he successfully produced clotting in a femoral aneurysm by employing a series of medical students to maintain continuous pressure on the artery. Morrant Baker was associated with the founding of the Evelina Children’s Hospital, where he devised the first red indiarubber tracheotomy tube, and invented the duplex-burner reading lamp. He died aged only 57, in 1896, from locomotor ataxia-ironically, a disease he had studied extensively. This remarkable man encompassed all the surgery of his time, tackling many problems to which only increased specialisation and sophisticated technology have eventually produced solutions. St. Bartholomew’s Hospital, London EC1A 7BE
M.
J.
HERSHMAN
Medical Student
