The history of postgraduate medical education at the West London Hospital.

FOR the writing of a general history of postgraduate medical education, the staff of the West London Hospital very kindly made available the original records of the West London Postgraduate College. These records proved to be complete, in the form of Minute and Account Books and a collection of various papers. The Minutes, although kept in books marked 'Medical Staff Committee' and 'College Committee', tend, fortunately for the convenience of research, to have been kept in order of time rather than by nature of Committee, so that Minutes which are apparently muddled together, in fact read as a continuous record. For this reason, what would have been an irksome mass of references can be avoided: anyone wishing to go over the ground need only have before him the few books covering the same period, and date alone gives all the information needed. So the dates given in brackets below can be ignored for reading purposes, but used for references. The books concerned are deposited in the Library of the Royal College of Physicians. What emerged from reading the records was that the West London's activities were much the most important attempt at postgraduate education in the nineteenth century, and although the outline of this story has already been given, it is worthwhile to put the further details on record. The basic fact about postgraduate education in the nineteenth century is this: after the first half of the century, that wonderful era in which medicine finally escaped from Galen and all the vital discoveries leading to modem medicine except one were made, medicine achieved a new stability, as the system of making diagnoses of named diseases on the basis of the discovery of the state of organs by physical examination, combined with progressive improvement in the instrumental methods of diagnosis. This made it almost possible to impart to a medical student, by the time he was qualified, a body of knowledge which would serve him for the rest of his clinical career. Almost-so nearly so that we are still suffering from, or were until very recently, the now mistaken idea that there is an adequate corpus of knowledge which every doctor must know, and that no more education is necessary after that has been acquired. There never was, in fact, a time at which this was strictly true: during the latter half of the nineteenth century it was all too nearly so. But modem medicine was beginning to develop, so that at the same time, gradually, the feeling grew amongst the more conscientious members of the profession that they needed something more, and by 1898, the year in which a number of postgraduate organizations were started, the concept was definitely established. The nearest approach to a definite date for the start of the postgraduate idea in England would be the (in many ways) annus mirabilis 1893, in the heart of that period of rapid adaptation to changing circumstances which the ultra-conservative, who could not bear the idea of change, referred to as 'the Decadence', which is exactly what it was not.