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[DEC. 26, 1953ORIGINAL ARTICLES

EDUCATION FOR ELIZABETHANS*

Lord RADCLIFFEP.C., G.B.E., M.A. Oxfd

A LORD OF APPEAL IN ORDINARY

* Part of the inaugural address given at Westminster MedicalSchool on Oct. 12, 1953. The full text appears in theDec. 18 issue of the school magazine, Broadway.

AT the recent congress on medical education muchwas said about the need for the future doctor to havea general education and a general background of culture.That is not a problem peculiar to those who are being

educated in the study of medicine. You will equallyfind today that those who are interested in, let us say,the technical training of engineers advocate the advan-tages of supporting their specialised knowledge witha wider general education. You will find that leadersof industry are begging that they should be suppliedwith a stream of persons not merely qualified to be expertsin their particular branch of study but also with a widergeneral background. It is one of the problems of ourtime. But what to do about it and how to solve it ? ’?You see, the times have changed since the days when

general education represented a recognised curriculum.It is quite right for the young person to wish to be aspecialist. If his wits are alive, he realises as he advancesin study the fascinations and the potentialities of his

particular subject, and he dives, rightly, head foremostinto it with all the enthusiasm that he can command.It is a good thing ; for to become a master of a craft is

something which gives a man self-confidence and a footingin life which he will not otherwise acquire. It is a goodthing.Remember, too, that the days when there could be

a man of universal knowledge have passed. The sheeraccumulation of vast stores of learning in each field,the great range of subjects which are now open to beincluded among the various branches of learning, haveput us a century, perhaps two centuries, beyond the timewhen any one man could say,

"

I represent universalknowledge and I see it all in all its branches under myeye, and I take a picture of the whole."Somebody once said that Sir Christopher Wren was

one of the last of those universal men. Others haveclaimed it for Goethe. But if it were possible in thosedays, it is not possible now ; and with this enormousaccumulation of specialised learning it has come aboutthat the old general curriculum upon whicheducation and culture were founded has broken up.The mould is broken and there is not that set course ofthe humanities in which we Were taught to believe in thepast.’ Indeed, we are now called upon to rememberthat the old general classical education in the humanitieswas in its day nothing but a vocational training to equipcandidates for the medieval Civil Service.

But, again, what is to be done ? We all agree thatwe should be better men and fuller men if we had behindus a wider range of education. I am sure Twenty Questionson the B.B.C., however assiduously attended, will notprovide the answer ; nor even the illuminations of theBrains Trust ; nor even, however well chosen, a courseof lectures on potted culture. But, if I may, I willmake two suggestions to you which may be of someassistance.

* * *

One is to keep your curiosity alive. I should like toput in a word for the value of curiosity as one of thegreat influences of civilisation. For it will come to pass,as you become a master of your own craft, that thecertainties recede, enthusiasms to some extent fade ;but if you can keep your curiosity and your inquiring

mind alive, that, you will find, will sustain you untilthe end. If I may say so, back your fancy ; let yourcuriosity take you into the paths which fascinate you orappeal to you and do not let it be dominated by what otherpeople around you or in the past have said are the great01 the important or the beautiful things. If you remaincurious and do not take things for granted, you will find,however specialised your path, that life is continuallyopening out before you and showing you new fieldsin which your mind can dwell.

It is taking things for granted and not asking whyand how they are there-the very denial of the scientificspirit-that makes people limited in their interests.We all look every day at the skyline of London and neverask ourselves by what miracle of energy and acquiredskill that great monument of St. Paul’s still dominatesthe skyline of the City, one of the great architecturalmonuments of the world. When we go to the countrywe look at the country scene and we never even notice,because it is so much there, that wherever we lookthere is a church spire which is part of the landscape.We do not set ourselves wondering by what miracle ofa continuity of civilisation we have come to take it forgranted that the church spire is an inevitable part ofevery country scene. * * *

In some countries, without a long history on record,it might not mean much to say,

" Keep your curiosityalive," because it might not lead very far ; but in this

country, in which we are so intimately tied up, whicheverway we move, with our own past history and the greatcivilisation to which we belong and have belonged, italmost requires going about in blinkers not to bereminded of it.

Last summer at Stratford, I was struck by the evidenceof the extreme popularity of Shakespeare’s plays in thiscountry today : crowds of people thronged the tl.eatreat every performance, standing outside in queues iur thechance of admission from a returned ticket for one ofthe five plays presented at the Festival. I see thatthe Old Vic are presenting two more-perhaps one ot thegreat Hamlets of our time-and are setting out on acycle of five years in which they will produce in dueorder every single play written by Shakespeare, a

dramatist 350 years back from our times and o1 whoselife and personality it would be true to say we knowalmost nothing.

I was wonaering whether this great feeling of responseto Shakespeare’s work today represents something thatis common between the situation of our time and thesituation of those times in which he wrote.

" What piece of work is a man !", he makes Hamletsay. " How noble in reason ! how infinite in faculties !.... in action how like an angel ! in apprehension howlike a god ! the beauty of the world ! the paragon ofanimals ! " So may we say as, with all the resourcesof modern civilisation at our command, we realise theunlimited possibilities that stretch before the humancreature-if only he will do himself justice.

Yet Shakespeare makes Hamlet place this creature,with all his potentialities, against a dark background :

"... this brave o’erhanging firmament, this majesticalroof fretted with golden hre, why, it appeareth noLhingto me but a foul and pestilent congregation of va,pour:;

"

So it may seem to us when we see the inmost secretsof Nature and the great resources that lie still untappedin the firmament conscripted to form the major instru-ments of man’s destruction. That seems to be the dilemmaof our time, and I think it was felt the dilemma of thetimes of the first Elizabethans.Do we at all share their solution when we face our

problems ? ’? They were a race strange to us. for all our love

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of their literature. They were greedy and avaricious,they were ambitious, they had a mania for power ; but

they were men who had a taste for magnificence, theyhad a taste for greatness, and they had a feeling for whatthey understood by Honour. By our standard they werecuriously indifferent to success. What mattered tothem was the glory of the attempt and the achievementand not the ultimate reward or recognition.You see it reflected so clearly in Shakespeare’s plays.

He wrote comedies, of course--lovely fairylight thingsbathed in an unreal sunshine, in which nobody wassupposed to take seriously what happened or the result." It is just the prettiest thing in the world," LordMelbourne told Queen Victoria about As You Like It.But what Shakespeare never wrote, as far a,s I can

remember, was a play in which the good man, whilefaced with adversity and tried by troubles, emergestriumphant and successful at the end. What he wrotewere these tragedies in which the great man-Brutus,Antony, Hamlet, Othello, Lear, Coriolanus-goesdown to ruin, and goes down to ruin with thosehe loves involved in his destruction ; not because of anychallenge that he in his pride had made to fate, notbecause of any vice which is being punished or avengedby the moral law in his person, but because he is in thehand of a fate that is hostile to him and by a darknessthat he cannot overcome.That is not a cynical or a desperate presentation of

man’s dilemma, because you do not feel while you watchthese plays, nor do you come away at the close feeling,that darkness in the end is triumphant. But they dothrow you back to the feeling that it is not success orfailure itself which is the thing for which man is set herein his environment, but that what matters is his total

gesture ; and that there are moments of great light in thelife of every person-moments to which all of us, withoutreason and without philosophy, respond-which justifythe human experiment. At the end, I think, you feelvividly that although the solution may be hid in mystery,at least it is plain that the answer is not now and thesolution is not here. That is something of what the

predicament meant to the Elizabethans.* * *

You may follow them further, if you care, in the worksof the man whose tercentenary we were celebrating lastyear-in Hakluyt’s account of the Elizabethan sailors.You will find a proud record of people of endurance andof daring who in little ships, of 20, 30, 50, or 100 tons,went out into the unknown Atlantic searching for theNorth-West Passage or out to the North of Scandinavialooking for the North-East passage-men who facedodds of all kinds without self-pity and without complaint,against powerful enemies and more powerful fleets,against ice and fog and storm, against pestilence anddisease, and men who at the same time had-or many ofthem had-a simple faith that they were in the handsof Providence in the risks that they were taking. Asone of them wrote in Hakluyt,

"God, who doth give limits to man’s times, and ordaineththe manner and circumstance of dying."

But, feeling themselves in the hands of Providence, theyfelt no less the need that they should show themselvesskilful captains and skilful sailors, and when the endcame, as it often did, in disaster and not in success,and one more ship and its crew went down in battle orthe storm, they closed the record with dignity and withoutlamentation. This is what Raleigh wrote of his friendSir Richard Grenville after the ship Revenge had sunkfollowing the fight with the Spanish fleet :

" What became of his body, whether it were buried inthe sea or on the land, we know not ; the comfort thatremaineth to his friends is, that he hath ended his life

honourably in respect of the reputation won to his nation

and country, and of the same to his posterity, and that,being dead, he hath not outlived his own honour."

Those are fine words.I do not think it out of place to recall the names

of those men, something of what they did and somethingof what they believed, in this beginning of your term inCoronation year, when we are told that we are to be thesecond Elizabethans and there is a second Queen Elizabethon the throne. It can not be wrong to recall that manyof those men were citizens of this very ancient city inwhich you do your work and that it was upon the Thames,almost under these windows, that" they hoist up sailand committed themselves to the sea," just as timeand the future years will bear you to your futures,which will be, as I so much hope, happy and fruitfuland not without adventure.

INVESTIGATION OF

OBLITERATIVE ARTERIAL DISEASE OF

THE LOWER LIMB

DAVID MESSENTM.B. Lond., F.R.C.S.

ASSISTANT LECTURER IN SURGERY

R. E. STEINERM.B.N.U.I., D.M.R., F.F.R.

LECTURER IN RADIOLOGY

JOHN F. GOODWINM.D. Lond., M.R.C.P.LECTURER IN MEDICINE

POSTGRADUATE MEDICAL SCHOOL OF LONDON

THERE is no general agreement about the value of thevarious tests used to determine the integrity of theperipheral circulation, and special investigations are

often considered to be of limited practical significance.The widening of the field of direct surgical approach

to diseased arteries has emphasised the importance ofan accurate knowledge of disordered function andanatomy. We therefore felt the need to comparevarious methods of investigation and to assess theirvalue, with particular reference to accurate diagnosisand treatment, and to ascertain which of these methodsmay usefully be retained in everyday practice. Ourconclusions are based on a study of more than 100

patients with arterial disease of the lower limbs, althoughit was impossible to make all the investigations on eachpatient.

Aims of InvestigationBefore any investigations can be discussed, their aims

must be clearly defined, and in the case of peripheralvascular disease these are as follows :

(1) To establish, confirm, and amplify diagnosis.(2) To distinguish between functional and organic arterial

disease.

(3) In the presence of organic disease, to obtain a preciseknowledge of : a, the site and extent of any arterial block;b, the condition of the arterial walls above and below the block;c, the number, size, and position of collateral vessels; andd, the patency and function of the arterial tree beyond the block,with particular reference to the potential blood-supply of theskin and muscles.

(4) To plan treatment.(5) To aid prognosis.

Methods of InvestigationArterial PulsationThe Pachon oscillometer was used at mid-thigh and

mid-calf levels and above the ankle.

Skin Blood-flowThe response of skin-temperature to indirect heating

was measured by the method of Lewis and Pickering(1931). Skin-temperature. readings of the big toe weremade on a Cambridge thermocouple skin thermometer.