PROBLEMS OF INTERNAL MEDICINE 217 



us in looking forward to the possible discovery of an explanation of 

 the mode of action of substances long empirically used, knowledge 

 the value of which may be readily appreciated. 



When we consider these facts it is indeed easy to appreciate to 

 what an extent the exact has driven the conjectural from this last 

 field of medicine. A hundred years ago we were depleting and purg- 

 ing and sweating and bleeding according to theories often strangely 

 lacking in foundation, the prevalence of which depended rather upon 

 the individual force and vigor of the expounder than upon their 

 intrinsic merit. To-day from the study of the pathological physio- 

 logy of bacterial and cytotoxic intoxications, we are rapidly evolving 

 scientific preventive and curative measures, while searching out the 

 rationale and mode of action of our older therapeutic agents. 



But a few days ago, I happened to open a copy of Littre" 1 bearing, 

 by a curious chance, the date of 1889, and read "Me"decine (me"-de- 

 si-n). 1. Art qui a pour but la conservation de la sante* et la gue"rison 

 des maladies, et qui repose sur la science des maladies ou patho- 

 logic " an essential modification of the definition of one hundred 

 years before and indicative of the changes of a century. 



To meet the manifold problems of to-day, the training of the phy- 

 sician must of necessity be very different from what it was a hun- 

 dred years ago. The strong reaction which set in in the earlier part 

 of the nineteenth century against philosophical generalization in 

 medicine, the insistence upon a strict objectivity, all the more em- 

 phatic because of the prevalence of anatomical methods of research, 

 have held very general sway. Medicine, no longer resting upon a 

 basis of philosophical speculation, stands upon the firmer foundation 

 of the exact natural sciences. Almost from the beginning the student 

 of to-day is taught methods, where a hundred years ago he was 

 taught theories. The enormous expansion of the field which must be 

 covered has led naturally, not only to an ever increasing specialism, 

 but to the fact that the course of study which is regarded as properly 

 fitting the physician for practice is reaching backward farther and 

 farther into the earlier years of his school training. On the other 

 hand, in this country at all events, there is heard a common cry 

 that the academic medical training is extending over into years 

 which should be given to practice ; that the expense and dura- 

 tion of a medical education, so-called, will soon be such as to shut 

 out from the profession many a man who might be a useful physi- 

 cian and perhaps a valuable contributor to the world's knowledge. 

 To remedy this it is advised that the prospective student of medi- 

 cine should be led from the earliest stages of his training through the 

 paths of exact research into the domain of the natural sciences to the 

 greater or less exclusion of the classics the old-time humanities, 



Dictionnaire de la langue franfaise. 



