Numerous advances and improvements in technique have taken place, such as the following: Bronchoscopy.—In diseases of the lungs the trial of new meth ods of treatment has gone on, such as specific or chemical reme dies, and the production of artificial pneumothorax (q.v.) (see THERAPEUTICS). As the presence of adhesions inside the chest interferes with the production of a curative pneumothorax, they have been divided by a cautery, the process being watched through a hollow tube, illuminated by electric light, passed into the chest (Jacobaeus' thoracoscopy). Bronchoscopy for the detec tion and removal of foreign bodies from the air-passages has, in the hands of Chevalier Jackson, become a fine art ; the impor tance of an early removal of these bodies before they have set up destructive changes in the lungs, which in the past have proved obscurely fatal, has now been fully recognized. In the abdomen a method, laparoscopy or coelioscopy, by which the contents can be seen by an arrangement similar to that of thoracoscopy, has been employed; but neither of these difficult methods is likely to come into general use.
Fractional Test Meals.—The adoption of fractional test meals as a more exact method of determining the constitution and varia tions of the constituents of the gastric contents has, thanks to Rehfuss, superseded the single examination made one hour after a test meal. Absence of hydrochloric acid, a normal constituent of the gastric juice, has been shown to favour the onset of per nicious anaemia (see ANAEMIA). Aspiration of the bile by a duo denal tube, after Oddi's sphincter, which closes the lower end of the common bile duct, has been relaxed by a spray of magnesium sulphate, enables a microscopical, chemical and bacteriological examination of the bile to be made, and also does good by drain age in cases of infection and inflammation of the biliary tract.
Tests for Hepatic Efficiency.—The search for tests to estimate the functional capacity, or the way the liver is doing its work, has been carried on with energy, and a number of tests for the individual functions have been introduced ; but no one test for them as a whole is satisfactory, and another difficulty is that the liver, like the heart and other organs, has a great reserve, so that it can, although much damaged, discharge its functions so well that tests do not reveal any failure of the compensated condi tion ; this is especially true in chronic disease. By means of a blood test—the Hijmans van den Bergh reaction—obstructive jaundice can be distinguished from other forms.
The physiology and pathology of the nervous system has steadily progressed ; the researches into the factors presiding over equilibrium and posture have yielded valuable information ; disease of the extra-pyramidal system has attracted attention; acute infections of the nervous system, acute polio myelitis, encephalitis epidemica ("sleeping sickness") and cerebro spinal fever were more prominent in the conditions of war than before ; much valuable scientific research into the methods of actions of poisons on the nervous system has been carried out.
Panel Practice.—The conditions of medical practice in Great Britain were profoundly modified by the intro duction, as the result of Mr. Lloyd George's National Insurance Act (1911 ), of the "Panel system," whereby 15,000,000 insured persons are now looked after by practitioners paid at a yearly rate of a sum which has averaged about ten shillings a year, paid partly by insurance contributions and partly by the state ; this enormous undertaking is part of National Insurance and is under the control of the Ministry of Health. No one medical man is now allowed to have more than 3,500 persons on his panel. At the time of its initiation the panel system met with great opposition from the medical profession, but this collapsed, and on the whole the sys tem works well, and is certainly an improvement on the old system of clubs. (See NATIONAL INSURANCE, HEALTH.) Diplomas in Special Subjects.—The enormous advances in medicine have made specialism necessary and inevitable, and as evidence of the general recognition of this need diplomas in these special subjects are granted by the universities and licensing bodies. The General Medical Council in 1922 revised the regu lations for one of the oldest diplomas, that of Public Health (D.P.H.), and ordained that two years, instead of one year as formerly, must elapse from the date of a candidate's obtaining a registrable qualification in medicine, surgery and midwifery before his admission to Part II. of the examination for diplomas in sanitary science, public health or state medicine. There are diplomas in psychological medicine, in tropical medicine and hygiene, in ophthalmic medicine and surgery and in laryngology and otology, and since the war the universities of Cambridge and Liverpool have given diplomas in radiology. (See MEDICAL EDUCATION.) Group Medicine.—The specialization of medicine and the elaboration of technique prevent any one man from being master of the whole field of medicine, and accordingly there has been a tendency for men to combine in team work or group medicine, especially in America. A group of men expert in their own lines may work together or under a general physician or surgeon who, in consultation with them, correlates the collected evidence and comes to a final decision on the whole matter. These diagnostic clinics, which are exemplified by the Mayo Clinic, Rochester, Minn., are commoner in America than in Great Britain. They should have the advantage, from the patient's point of view, of providing for a fixed inclusive fee all the special examinations that may be necessary at a lower cost than in ordinary practice would be required for such a number of tests.
bibliographies to the articles referred to in the text ; also Sir T. C. Allbutt and Sir H. D. Rolleston (editors), A System of Medicine, 9 vol., various dates. (H. R.)