Neurology — Wilder Penfield 



25 



contemplating one organ becomes oblivious 

 of function in the others. 



Finally, the good physician knows that 

 special knowledge is not enough. The hu- 

 man being under his care needs sympathy 

 and understanding as well. Consequently, 

 busy with many demands on his time and 

 thought, the specialist must have the scien- 

 tist close at hand to help him in his spec- 

 ialty. 



There are two major departments of 

 medicine which deal exclusively with af- 

 fections of the nervous system at present: 

 neurology and neurosurgery, and psychiat- 

 ry. In each there is an enlarging field for 

 basic science. 



Institutes of Medicine. There is only one 

 solution for the over-all problem of medi- 

 cal centers where leadership, scientific and 

 clinical, is expected. That solution is the 

 establishment of institutes of medicine. 



In 1875, a youthful botanist,* histologist 

 and physician, by the name of William 

 Osier, was appointed Professor of the "In- 

 stitutes of Medicine" at McGill University. 

 At the time of his appointment he was 

 teaching histology amd physiology and 

 spending long hours labouring at path- 

 ology in the autopsy room of the Montreal 

 General Hospital. In due time Osier turned 

 from his effort to learn all the existing basic 

 biological science and focused his atten- 

 tion on diagnosis and therapy. That was 

 the evolution of a great physician and 

 leader of thought in clinical medicine sev- 

 enty years ago. 



But today the story is a different one. 

 There is still need for the internist, the 

 universal diagnostician, but he must be 

 flanked by specialists in treatment and di- 

 agnosis. It is still best to give these men 

 preliminary training in basic science, but 

 now even the most energetic can master 

 no more than one field and to be effective 

 in it he must develop a team of workers. 



The word "institute" should be given a 

 new definition. A clinical institute is a 

 group of men who study and investigate 

 the problems in a specific field and who 



* O.sler had been offered the Chair of Botany 

 at McGill in 1872. 



treat patients in that field. A neurological 

 institute or a psychiatric institute may be 

 constituted by a group of clinicians who 

 treat and study the diseases of the nervous 

 system on the one hand and the mind on 

 the other. But if the clinical group is to 

 deserve the name of institute, there must 

 be added workers in basic science, men 

 with an adequate training who are willing 

 to take the patients' need as guide in the 

 selection of their problems. This addition 

 creates a new classification of workers, 

 workers in applied science. 



Applied Sciences. It is obvious that 

 science must be brought to the bedside or 

 into nearby laboratories. In the case of 

 neurology and psychiatry, the applied 

 scientist may some day show us that there 

 is no difference in the two fields, that the 

 cause of mental derangement and normal 

 intellectual processes may be understood 

 in terms of abnormal and normal brain 

 function, and so the two fields will one 

 day merge into one. Psychiatry and neu- 

 rology will be one specialty and not two, 

 and the therapy will be discriminating and 

 effective. Cnide surgical ablations will 

 have disappeared on the one hand and 

 fumbling psychoanalysis on the other. 



This therapeutic utopia may seem very 

 far ahead of us, but wise medical educa- 

 tors should recognize now that the basic 

 science of the one department does not 

 differ from that in the other, and much of 

 the basic training of neurologist, psychia- 

 trist and neurosurgeon should be the same. 



Workers in applied science may be full 

 time laboratory men, but more often they 

 should also be part time clinicians. The 

 latter arrangement may introduce a little 

 lower level of excellence into their lab- 

 oratory work. But that is more than bal- 

 anced by the fact that each man is able 

 to turn from the bedside to laboratory 

 bench and back again with greater insight 

 in each of the two spheres of study. 



Applied biological science is different in 

 some respects from basic science and it is 

 certainly different from the art of the 

 practice of medicine. But applied science 

 can provide the indispensable bridge be- 

 tween these two great departments of hu- 



