The usefulness of this most interesting report will certainly not be confined to the Sudan. As the medical training of African natives in British Colonies develops there is little doubt that this record and subsequent reports from the same source will serve as valuable guidés and works of reference. It is a pioneer document and although wholly concerned with the problems of medical education as they affect the Sudan, it indicates certain sound principles which have a wider application and provides information which cannot fail to be of service elsewhere.
Attractive in form, for it is exceptionally well printed and illustrated, it possesses rather a special feature in that there is a résumé of the first report, a useful provision which tells from its beginning the story of an undertaking that marks a new era in the history of the Sudan and the importance of which can scarcely be overrated.
The Medical School, founded as a memorial to Lord Kitchener, was opened by Sir Lee Stack in 1924. Its aim and objects are thus described: " (a) To train carefully selected students of the Gordon Memorial College as doctors in order that they may carry out Medical and Health work in their own country, and thus not only to bring medical help within the reach of the large number of their own countrymen who are out of reach of all medical assistance, but also by preventive measures to raise the general standard of health throughout the country,
" (b) As the need arises, to provide post-graduate classes for doctors who have been trained at this School.
" (c) By working in close co-operation with the Medical Research Laboratories, to inculcate the spirit of clinical research and to afford facilities for such research to graduates who show this aptitude."
The course is one of four years' duration, followed in every case by a year's work as house-surgeon or house-physician at one of the larger hospitals. It is defined as " a sound scientific but somewhat simplified medical training." The details given certainly confirm this statement. It is hoped that eventually the medical work of the Sudan will be entirely conducted by graduates from this School with the exception of a small cadre of British doctors, specialists in medicine, surgery, public health or medical administration.
Care is taken to limit the number of students. Thus when the School opened ten were admitted. In 1925 there were eight new students. In 1926 no fresh students were enrolled, but in January, 1927, ten new students from the Gordon College commenced the first year course of studies. The students are under close surveillance. Those who fail in their examinations are either referred back for a further course of study in the subjects wherein they have failed to satisfy the examiners or, if deemed wholly unsuitable, are recommended to discontinue their studies and are given Government employment.
Progress has been steady and we learn from the report that in December, 1927, seven of the original ten students who entered the School in 1924 passed the final examination and were granted licences to practise medicine and surgery within the borders of the Sudan. They now hold hospital house appointments. Those of them who exhibit the necessary knowledge, skill and administrative ability will be placed in charge of certain of the smaller hospitals. Those who do not will remain for a further period under supervision at one of the larger hospitals.
An interesting photograph shows a group of these graduates with a Sudanese benefactor of the School. When one remembers that little more than a generation ago the Sudan was in a state of savagery and barbarism this picture is a remarkable testimony to the beneficent work of the civilizing Power.
The method of conducting the examinations is described. In 1926 one assessor was appointed from Egypt, in 1927 both a surgical and a medical assessor were invited to attend. The report of the assessor for 1926 and that of the assessors for 1927 are given as appendices and merit careful attention. They are distinctly favourable, but make certain recommendations for improving both the teaching and the examinations. Those in the 1927 report are as follows: -
" (1) Still greater care to be paid to the practical side of the medica work, especially in regard to Practical Pathology in which we are of the opinion that a supplementary examination should be held at the same time as the other examinations, more particularly in regard to clinical pathological subjects.
" (2) As soon as possible the institution of a Pathological Museum in the new Medical Research Laboratories opposite the School.
" (3) The construction of a Graphic Museum on the model of that now existing at the Bureau of Tropical Research [sic] in Endsleigh Gardens. This will be of extreme value, more particularly in the consideration of Tropical Diseases; and in regard to the encouragement of visual education and memorization by Sudanese doctors on their periodical return for post-graduate courses of instruction.
" (4) Further instruction in X-ray and radiographie examinations in connexion with clinical subjects."
The new Medical Research Laboratories above mentioned, which take the place of the medical section of the Wellcome Tropical Research Laboratories formerly at the Gordon College, occupy a building in the Hospital enclosure, immediately opposite the Medical School. An aerial photograph shows that the building containing them is identical in external structure with that which houses the School. These two buildings flank the southern end of the long, wide and tree-fringed avenue which runs from the railway station to the palace gardens. It is expected that the laboratories on their new site will greatly assist the teaching both of pathology and of clinical work.
A School Hostel has also been erected and can accommodate forty students.
At the Gordon College itself preliminary scientific teaching has been given to fourth-year students since January, 1926, so that students starting work at the Medical School are not handicapped by the lack of a scientific vocabulary and the absence of any knowledge of science and its applications.
The Government has provided scholarships for suitable students who, without monetary aid, would be unable to complete their medical studies.
There is a list of the teaching Staff, the members of which are, for the most part, officials of the Sudan Medical Service, but, to ensure continuity of teaching in biology, a lecturer in that subject has been appointed.
The curriculum is described and one of the appendices gives the revised syllabus in detail. This is a very useful addition and will be helpful in other parts of British tropical Africa. It has evidently been the subject of careful consideration and would appear well calculated to fulfil the purpose for which it is intended, the large provision for practical work being specially noteworthy. One small criticism only may be advanced. Under blood work nothing is said about instruction in those fallacies and puzzles which form pitfalls for the unwary and which it is specially necessary to guard against in a country like the Sudan.
The demonstrations given in connexion with the public health course are excellent.
The Report contains an account of the presentation of the diplomas and of the Governor-General's admirable speech on that occasion. It is interesting to note that each student was called on to swear the Oath of Hippocrates, which was recited in Arabic.
Finally there is a financial statement, which recalls a passage from the Assessor's Report for 1926 to this effect: -
" The foundation of the Gordon Memorial College, the extraordinary advantage of being able to make use of the facilities afforded by the Wellcome Tropical Research Laboratories and the existence of a most skilled and efficient teaching staff in all the scientific subjects already in Khartoum, obviate the necessity of importing expensive professors from abroad, and result in the institution of what is probably the cheapest, consistent with efficiency, School of Medicine in the world."
Mr. O. F. H. Atkey, who signs the report and who is President of the School Council and Director of the Sudan Medical Service, is to be heartily congratulated on this record of work and on the manner in which the Kitchener School of Medicine has developed and is being conducted. He and his colleagues have devoted themselves to the task with a well-regulated enthusiasm which is meeting with its just reward, and anyone who reads this report is likely to agree with the third paragraph under the heading " Dedication, " which runs: -
" Every year that has elapsed since Lord Kitchener's death has served to emphasize his wisdom and foresight in this matter."
Andrew Balfour.