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JUN10 101

South African Medical Record

VOL. II.-No. 1.

A Monthly Journal devoted to the interests of the Medical Profession in South Africa

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CAPE TOWN, JANUARY 15, 1904

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South African Medical Congress.

The sixth South African Medical Congress opened at Cape Town on the 28th of December, after an intermission of four years, due to the war. The attendance, both of local practitioners and those from outside, was good, although the latter was mostly from the Western Districts of the Cape Colony, a fact not to be wondered at, considering the magnificent distances of this subcontinent, and the special difficulty which men with the very best of intentions find in leaving their practices so soon after the general upheaval caused by the war. There were, however, three representatives from Natal, one from the Transvaal, three from the Eastern Province of the Cape Colony, and one from Kimberley. Neither the O.R.C. nor Rhodesia were represented.

GENERAL BUSINESS.

Prior to the formal opening of the Congress, a day was devoted to business of a general nature, Dr. Stevenson, the President, taking the chair, and welcoming the members in a few well chosen words.

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Dr. Darley-Hartley then read a paper on the formation of a Medical Guild, pointing out in general terms the absolute necessity of combination amongst medical men, not only for the securing of just remuneration and rightful privileges, but for expressing the views of the profession as a body, and preserving it from that loss of ethical tone. which invariably followed overcompetition and the res He reminded his hearers that all the angusta domi. world was combining nowadays, and that if they neglected to follow suit they would certainly be crushed between upper, nether and circumferential mill stones. He read the draft Constitution, which has already appeared in these columns, and emphasised the fact that it had no authoritative character, but had only been prepared as exhibiting the general idea of a Guild in a clearer way than could be done in a mere paper. He and those who had worked with him in preparing this draft wished it to be clearly understood that, if it were thought practicable, they were most anxious that the scheme, merely drafted with a view to the Cape Colony, should be applied to the whole of South Africa at once, as they knew it would have to be so applied eventually to be anything of a success. He then moved a resolution formally approving the idea, and empowering a Guild Council to be elected by Congress, to take the requisite steps for forming the Guild for the Cape Colony on the lines indicated in the draft Constitution.

Dr. G. G. Eyre briefly seconded.

Dr. C. F. K. Murray was thoroughly in favour of the proposal, but thought that it would require very careful digestion before fixing on its details, and that it should be applied to the whole of South Africa.

Dr. Currie (Maritzburg) said he had no hesitation in speaking for the colony of Natal to the effect that his confreres thoroughly recognised the need of combination, although they might not agree on reflection with all the details. The profession as a whole had never been able to combine for business purposes, and they must do so Medical matters in Natal were fairly well organised, with one branch of the B.M.A. for the whole colony and three local societies, but these did not altogether cover the ground of a Guild. If some corresponding members of the Committee were appointed for Natal, he felt certain, although he could not, of course, speak with authority, that, after all the details had been threshed out, almost every member of the profession in his colony would join in the formation of a Natal centre.

Dr. Napier said that the scheme had not been considered sufficiently carefully yet, although it had appeared in the MEDICAL RECORD. He entirely approved of the broad idea, but it involved a mass of detail, and it was not a thing to rush into. To be any good, it must include all the Colonies, and if it did, a large number of practitioners would join. He moved as an amendment

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SOUTH AFRICAN MEDICAL RECORD

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"That the proposal is considered by Congress advisable, and that therefore it appoints a committee to consider the whole subject."

Dr. Balfe (Durban) seconded the amendment.

Dr. C. F. K. Murray supported the amendment. He considered the scheme an excellent one for the profession, and he should like to see all the Colonies come in, but he thought its details should be carefully approached through the medium of the various Medical Societies.

Dr. Mackenzie (Durban) was entirely in accord with the idea, but he thought that even if a year's delay was involved, it was necessary to start on a sound foundation, involving all the Colonies, and Dr. Napier's suggestion to appoint a committee which could confer with all the Medical Societies in South Africa was a good one.

Dr. Darley-Hartley said that, with the consent of his seconder, he was quite prepared to substitute "South Africa" for "Cape Colony," but he thought it rather a pity to delay a year. The only difference between his proposal and the amendment was that he proposed to give a Council power to act for one year, and the amendment, only contemplated a Committee to consider. He reminded them that if his resolution were carried, it was expressly stipulated in the suggested Constitution that the whole scheme would come into the melting pot again at the next Congress. Dr. Napier's amendment seemed to him hardly definite enough.

Dr. Napier then re-drafted his amendment to read as follows: That this Congress, while endorsing the principle of the formation of a guild, is of opinion that a committee should be formed to consider the whole question, and draw up a scheme of a similar nature; and that the committee be instructed to communicate with the medical societies of the different colonies with the object of making the scheme applicable to the whole of South Africa, the committee to report to the next Congress."

The amendment was carried, and the following committee appointed.

Drs. Darley-Hartley, Stevenson, Murray, Eyre, Wood and J. Hewatt. (Cape Peninsula): Drs. Strapp and Currie (Maritzburg): Dr. Temple Mursell (Johannesburg): Dr. Dalgleish (Bloemfontein): Dr. Strong (Bulawayo): Dr. Greathead (Grahamstown): Dr. Watkins (Kimberley).

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his study by a course in the great centres of medical teaching.

Dr. Darley-Hartley said he was only partially in favour of the formation of a South African Medical School. He had come to the conclusion that it would be an admirable thing for teachers, but he was not inclined to think that it would be a good thing for the students. It would certainly develop a sound class of specialists; but for the first twenty years it would be inefficient. If he personally had a son to send to medicine he would be sorry for that son if he was sent to such a medical

school as proposed. Instancing the South African School of Mining, Dr. Darley-Hartley contended that the difficulties which that school had to encounter were enormous, and the study there was not equivalent to that obtained at Home. He confessed that he agreed with Mr. Rhodes that it was best for a young man to get his early education in South Africa, but that it was also best for him to go Home to complete it among the venerable surroundings of England, Scotland, and Ireland. Dr. Hartley affirmed that the Home universities broadened a young man's experience, and taught him to be and act like a gentleman. Regarding the Australian medical schools, the speaker said there was a great deal of diversity of opinion about them. A great many Australian practitioners were of opinion that they were really not of so much value as people make out. Dr. Hartley concluded by saying that although he did not want to throw cold water upon the scheme. he would certainly advocate caution,

Dr. Casalis considered that the time was not yet ripe for establishing a medical school in South Africa.

A MEDICAL SCHOOL FOR SOUTH AFRICA. Dr. E. B. Fuller then read a paper on the above subject, which is given in extenso elsewhere.

Dr. C. F. K. Murray, said that he had always been in sympathy with the idea of a South African Medical School, and that he thought that, inasmuch the great difficulty, that of an insufficient population, had now disappeared with the growth of such places as Cape Town and Johannesburg, the time was ripe or nearly ripe. Sir Michael Foster half a dozen years ago had expressed to him his surprise that they had no medical school, and had told him that there were even then no difficulties in the way of a reliminary course that would be recognised by Cambridge. He thought that now they were quite ready for a complete course. Now that post-graduate schools had opened all over Europe, there would be no difficulty in any South African graduate supplementing

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Dr. McKenzie (Durban) said that while he was thoroughly in sympathy with the object of Dr. Fuller, he thought that such a school would not be in an efficient state for years to come, he was, however, of opinion that preliminary study should be completed in South Africa, and that this study should be placed to the student's credit at Home.

Dr. Currie (Natal) supported Dr. Fuller's proposal. They all knew what influence a university had upon the country in general. The question of a medical school was bound up with a university. (Hear, hear.) It was time that the Cape University woke up to its position and became a teaching university like the London University. He considered that the time was now ripe for establishing a medical school in South Africa. Dr. Currie took exception to the remarks that had fallen from Dr. Darley-Hartley that a man ought to go Europe to learn how to become a gentleman. A man's character was not formed at a university, but as a child in his own home. He considered that the boys brought up in the South African College were quite as fit to take their place among gentlemen as any. It

Dr. Griffiths (Cape Town) sugported Dr. Fuller. had been contended that they had not enough men in South Africa capable of teaching. If that were so, the sooner South Africa cleared them out the better. Dr. Griffiths quoted several names of South African practitioners who would adorn professional chairs.

Dr. Richardson speaking as a newcomer, said it would be difficult to establish a medical school, but easy to start a post graduate school.

Dr. Dixon agreed with Dr. Richardson.

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Dr. Napier (Transvaal) was inclined to think that South Africa was not ready for a medical school. He considered that a student ought to go Home to widen his mental horizon. He did not believe that the profession was at all benefited by having medical schools in Australia. The doctors in Australia were very poor specimens, and that was largely due to the fact that they had medical schools of their own.

The Congress then adjourned for lunch.

The afternoon proceedings were presided over by Dr. C. F. K. Murray, President of the Cape Medical Council.

A telegram was read from Dr. Greathead, Graham's Town, regretting that urgent affairs prevented him from attending Congress.

Resuming the discussion on Dr. Fuller's paper,

Dr. Beck expressed regret that he had not heard the paper read, or the discussion which had occurred, during the morning. He declared himself in thorough sympathy with any movement which would tend to make South Africa a more self-reliant country. No provision was too liberal to make if it contributed to advance a profession like that of medicine, which he was glad to think was taking its position more and more in the van of true progress. They ought to consider not how such a movement would act on their own material prosperity, but how it would affect the development and welfare of South Africa, and, through South Africa, other portions of the world. Dr. Beck recounted the steps which he had taken some years ago in trying to get teaching in medical subjects in the South African College, at the time when a school of mines was projected. He thought then that with the existing chairs, the way would be paved for medical teaching, and he thought further that with the development which had occurred in Somerset Hospital, it was not out of the region of reasonable practicability that Somerset Hospital might be utilised for the teaching of preliminary medical subjects. With science teaching organised here, as it was to-day, with provision made in the large colleges for practically every department of science teaching which could possibly be expected, he thought it was a responsibility which they could scarcely throw from their shoulders-a responsibility which they, as a medical profession, should accept as peculiarly theirs, to make effort every way they were able to persuade the authorities to act in order to bring the science teaching into some kind of affiliation with the requirements of young men desirous of embracing that profession. In reference to a statement made in the course of the discussion that it was necessary that young men should go abroad to be educated, he (Dr. Beck) took exception to that view. No man laid greater stress on the importance of a wide experience, and a wider horizon, as a help to the development of a man than he did, and therefore if they could bring about a condition of things by which every man and woman in this country could be sent to Europe-sent into the wide world, they should do so. But he joined issue entirely with those who told him that a man's education need necessarily suffer because he did not go away from South Africa. Let them take the Bar, for instance. They had no reason to be ashamed of men who practised to-day at the Bar, and who had received their education entirely in South Africa.

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Dr. Fuller said he would move:-"That in the opinion of this Congress it is desirable that a medical school be established in South Africa at as early date as may be found possible." This resolution would not bind them to any definite action, and he thought it perhaps better at this stage they should not be bound too closely to any definite line of action. But if this resolution were passed it would show that the large bulk of medical men in this country were in favour of the idea of developing a medical school here, and it would give encouragement to those who were working on educational lines such as Dr. Beck had sketched. Replying briefly on the discussion, Dr. Fuller said they would never get a satisfactory post-graduate course established until they worked up gradually to a complete medical course. It would be a mistake to start at the other end and commence a post-graduate course before they had the means at their hand.

Dr. Balfe (Durban) seconded the motion.

Dr. Darley-Hartley moved as an amendment: "That it is desirable that the University and teaching bodies should make full provision for the teaching of the preliminary scientific subjects of the medical curriculum and for the conferring of an arts degree for the same, and recognition of that degree by the licensing bodies." This went no further than to advocate the furthering of the present scheme of teaching here.

Dr. Kitching asked whether Dr. Darley-Hartley proposed to include physiology and anatomy.

Dr. Darley-Hartley: No.

Dr. Kitching said it seemed to him that all the other subjects were taught here now.

Dr. Currie said he was prepared to vote for the motion and the amendment.

The amendment was not seconded.

Dr. Beck moved as an alteration to the amendment, which he hoped Dr. Darley-Hartley would accept : "That this Congress favours the gradual development of a medical school for South Africa, With a view to promoting this, it urges strongly the immediate desirability of providing in our University for a medical science. degree, embracing the subjects and as far as possible satisfying the requirements of similar degrees in British and other Universities of Europe. It further affirms the desirability of making provision as soon as possible for the teaching in suitable institutions of physiology and anatomy."

Dr. Darley-Hartley accepted Dr. Beck's alteration, and begged to second it as an amendment in lieu of his

own.

Dr. Wessels said he was in sympathy with the amendment and resolution. Referring to the John Hopkins University in Boston, he (Dr. Wessels) was unable to see why they should not possess a postgraduate course here in South Africa of a similar nature. He believed that the teaching of anatomy should be carried on in the hospitals as well.

Dr. McGowan Kitching supported Dr. Beck's amendment.

Dr. Fuller said that Dr. Beck's amendment was simply an amplification of his own. The matter was simply one of evolution. He begged to withdraw his own resolution in favour of Dr. Beck's amendment.

Dr Beck's amendment was unanimously adopted.

The Chairman, in closing the discussion, said that they were all very grateful to Dr. Fuller for his paper and for the interesting result to which it had led.

RECIPROCITY.

Dr. McGowan Kitching read a paper on the principle of reciprocity in the regulations of medical practitioners in South Africa. Great Britain excluded foreign doctors, with one exception, Italy, which allows foreign medical men to practice under certain restrictions, and in return for that Great Britain made concessions. All other European countries excluded foreign qualifications. Australia and New Zealand also found it necessary to restrict the opportunity for foreign degrees counting as registerable. Dr. Kitching then dealt with the attitude of Natal, the Orange River Colony, and the Transvaal in the matter. South Africa was a British possession and not a German or French one. There were ample opportunities of learning the profession in one or other of the British schools, and there was no reason why they should admit foreigners, who universally refused to reciprocate the privilege. Although at present they did not educate their own doctors in South Africa, still that would come in time. Dr. Kitching ridiculed the idea that the restrictions would tend to deteriorate the profession, and so prevent South Africa from having the best talent. The supply of doctors would always be large enough without introducing foreign diplomas to oust the British,

Dr. Kitching then proposed: "That the Congress recognise the justice and reasonableness of the reciprocity clause in the regulations of the Medical Council of the Colonial Government of the Cape in 1902."

Dr. Symonds seconded the motion.

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Dr. Darley-Hartley supported the proposition. said it was one of those points for which he had fought very strongly in the past. He supported the motion, first, for this reason, he did not see why any country should go out of its way to concede to other countries privileges which those countries refused to concede itself, unless it be that there were some special circumstances which rendered it to the advantage of that country to concede such privileges. Supposing other countries for probably perfectly good reasons considered it necessary, that all persons who practised medicine in their own countries should be trained under the eye of their own Government, he thought they should presume that when those countries took that view with remarkable unanimity there was a good deal to be said for that view. Why should we in this colony go out of our way, apparently to our own detriment, to extend a liberty which was not conceded to us? He might at once be met with the argument that this country was not England, or Ireland, or Scotland, and that consideration might obtain in favour of our taking a special line of action if we had a medical school of our own. Then it might be desirable to legislate against England, Ireland, and Scotland much in the same way as the Cape Medical Council had legislated against foreign countries, but so long as we had no school of our own, they were in a measure part of the same country. Surely we had much the same obligation towards England as Texas, Arizona, or California had towards the United States. Secondly, there was this

important point, that, in considering the question of reciprocity, we should remember that even when absolute free-trade obtained in medical matters here, even when we were admitting everyone, the proportion of South African students who went elsewhere than to the United Kingdom to study and to obtain their degrees was infinitesimally small. That showed that by excluding practitioners from outside countries they in South Africa. would not be in any way going counter to the sentiments of their sons, born and bred in South Africa. By this means he considered they would more easily obtain that solidarity in the profession, the want of which they so often deplored. They wanted to look at things more through the same spectacles. Unless they had their medical men educated under the one set of traditions they would never be able to get that solidarity. Dr. DarleyHartley concluded by referring to what was done in other countries and colonies in the matter of reciprocity.

Dr. Beck said that he had raised his voice in an unpopular cause before, and his motives had been misconstrued. He had raised his voice against these restrictive measures, and people had said that he wanted to swamp South Africa with foreigners. That was absurd. He took up his present position because in a liberal profession like theirs it was unworthy to bind it under hard and fast restrictions. The only test they should exact was the test of ability in the profession. The present position was a narrow position to take up. Dr. Kitching, unwittingly, had made several mistakes in his paper. He had said that England gave reciprocity, which other countries refused. England gave no more or no less than other countries did. Besides it was an absurd thing for them in South Africa with a small population to take up an attitude similar to any of the large countries. That kind of reciprocity was utterly absurd. What they asked Germany to do was, "If you admit our degrees we will admit yours." But they had no degrees of their own. If it was simply a question of reciprocity then it was a question for England to negotiate. In German colonies, British graduates in medicine could practise if they chose. Again, were they going to shut out the culture which foreign universities could give them? The British Empire was a very large one, and comprised a great number of nationalities, and it would be unreasonable to compel the son of a German parent to qualify in any other university than that where his parent qualified. It was preposterous to say that because people were born in a British colony, a student must go only to an English university. A great number of foreigners were British subjects, and it was a fatal thing to shut their doors. In looking through the register he was surprised to find how few foreign doctors were in practice, and as the country became more and more English speaking, these would certainly decrease. It was a mistake to say that British colonies shut their doors to foreign degrees. In Canada certain French degrees were admitted.

Dr. Darley-Hartley: Only in the province of Quebec. Dr. Beck (continuing) said Quebec was at any rate a large province. In Australia there was nothing to prevent a foreigner practising provided he satisfied the requirements. Supposing they applied this restrictive legislation to the teaching profession, that would be a great blow, because in that case they would have to

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