(1839–1910) Medical history in Japan - Wellcome Trust

preclinical courses in areas such as anatomy and physiology;students had to move to another institution for their clinicaltraining. There didn’t appear to be a particular reason for theestablishment of the medical school in Cardiff, but of thoseput forward at the time, the idea that no self-respectinguniversity would wish to be without a medical school seemsfar more convincing than, for example, the argument thatresiding near their own homes offered Welsh studentsmaterial and moral advantages. But nationalism undoubtedlyplayed a part; the school was seen as an expression of Welshnational pride. So, too, did the role played by leading localpersonalities, many of whom made generous financialdonations to the setting up of the school, which continuedas the school expanded. Even so, finance remained aconcern for the whole of the period covered by the book.Although turf wars, as various departments withinthe College and within its medical school vied for financefor accommodation and equipment, were often evidentduring this period (as were personality clashes andresentments over professorial appointments), these wouldhave hardly marked out the school as being any differentfrom any other university, then or now. What placed theschool at the forefront of medical schools at this timewere progressive moves such as the founding of the firstChair of Preventative Medicine in the UK and a Chair ofTuberculosis, the only other one in the UK at the timebeing at Edinburgh. The school admitted women medicalstudents from the very start, and it is of note that of the 64medical graduates of the University of Wales in the period1916–1931, 22 were women. By contrast, many of the Londonmedical schools still did not admit women at this time orwere terminating their policies of admitting women.The problems for the school, which were to culminatein 1928 in “a crisis unparalleled in the modern historyof medical education in the UK”, stemmed from twointerrelated issues. The first was the desire to develop it as afull medical school, the Welsh National School of Medicine,offering both preclinical and clinical instruction. This wasachieved in 1921 when facilities for clinical teaching andresearch were provided at the Cardiff Royal Infirmary,which ipso facto became a teaching hospital. However, theagreement reached between the hospital and the College washasty and ill conceived: the College retained administrativecontrol, and the school remained a constituent part ofthe College. Tensions between the hospital staff and theschool staff and students were apparent from the start, andthe introduction of the avant-garde clinical unit system,whereby a department was under the complete control ofthe medical school, or at least jointly controlled by the schooland the teaching hospital, was deeply resented by manyof the hospital staff, despite the fact that its establishmentled to funding from the important Rockefeller Foundation.The failure to give hospital staff, especially the recognisedclinical teachers, representation on the Faculty of Medicine(the medical school’s supreme academic authority) provedto be another source of disquiet. Much of the problem,as Roberts so ably describes, emanated from the schooltaking as its partner an old-style voluntary hospital andfailing to manage its transition into a teaching hospital,and in particular in its failure to understand, let alonecater for, the views of the hospital staff. Consequently, thedifferences between the school and hospital staff, and theresultant tensions, grew to the point where relations finallybroke down altogether during the spring and summer of1928. By the summer of 1928, one-third of the recognisedclinical teachers were refusing to participate in the teachingprogramme. In June of that year, the hospital gave the schoolnotice to quit the hospital premises, and in Septemberinstituted a ‘lock-out’ of school students and staff followinga student fracas. This resulted in existing clinical studentshaving to enrol elsewhere to complete their studies andthe school having no clinical students at all in 1928/29.The second issue was that of the school beingindependent of the College, a move that had beenrecommended by the Haldane Report in 1918 but successfullyopposed by the College, which in this seemed to have thesupport of the Welsh public. However, this was an issuethat was to continue to be raised, particularly by thosewho wished to see an independent and truly nationalmedical school, with an all-Wales remit, not affiliatedto any of the existing University of Wales colleges. Withthe problems that surfaced at the school in 1928 this ideacame to the fore as part of their solution, along with theresolution of many of the problems that caused so muchtension at the hospital. Despite the bitter opposition ofthe College, which had invested heavily in founding anddeveloping the school, independence was finally achievedin 1931. However, what emerged was an example ofgood old-fashioned British compromise, with the schoolbeing split into two: the preclinical departments, such asanatomy and physiology, remaining with the College, andthe remainder being transferred to the new entity, whichbecame an independent college within the Universityof Wales. While Roberts’ account ends at this point, itis not the end of the story for, as is often the case, thewheel turned full circle and in 2004 the school, by thenthe University of Wales College of Medicine, mergedwith its one-time parent to become Cardiff University.No review such as this can ever convey adequately thedegree of complexity involved in the story unveiled byRoberts, and he is to be congratulated on disentanglingthe issues so that they become more understandableto the reader. While Roberts takes us deftly throughthe twists and turns of the drama, neatly unfolding thevarious arguments, he also usefully discusses the broaderperspectives, briefly examining developments in medicaleducation as a whole, and comparing developments atCardiff with those at other UK medical schools. Finally,the inclusion of vignettes of the characters involved and ofstudents at the school within each chapter helps to makethe story come alive, as well as providing a useful insightas to why some of the combatants behaved in the waythey did. Undoubtedly this well-researched book, and itscomprehensive bibliography, will be of interest to a wideaudience, whether the main focus is the history of medicaleducation, the history of Welsh life and politics in the firstfew decades of the 20th century, or organisational behaviour.In the preface, Dr Roberts hints that there may be anothervolume under consideration, taking the story to 2004.This reviewer, for one, looks forward to its publication.Dr Keith Williams is a Research Associate of the Department of History at theUniversity of York (E kcwilliams@ic24.net).Roberts A. The Welsh National School of Medicine, 1893–1931: The Cardiff years.University of Wales Press; 2008.14 | Wellcome HISTORY