NATURE 



389 



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THURSDAY, DECEMBER 18, 1919. 



PHYSIOLOGY AND MEDICINE. 



Physiology and Biochemistry in Modern Medicine. 

 By Prof. J. J. R. Macleod. Assisted by Dr. 

 Roy G. Pearce and by Others. Pp. xxxii + 903. 

 (London : Henry Kimpton, 1918.) Price 

 37s. (>d. net. 



TEACHERS engaged in giving instruction in 

 physiology to students of medicine are well 

 aware of the difficulty pointed out in the preface 

 to the book before us. The student, mainly out 

 of ignorance, is apt to regard the subject as of 

 no importance in the practice of his profession, 

 and to devote what attention he gives to it simply 

 to what he believes will enable him to pass some 

 particular examinational test. He rarely acquires 

 real and useful knowledge of the fundamental pro- 

 cesses at the basis of all the manifestations of vital 

 phenomena, normal and pathological, a knowledge 

 which he usually regards as purely "academic." 

 He fails to realise how great an assistance in the 

 comprehension of complex states he would obtain 

 by the application of such general principles. It 

 is to be feared that this attitude is too much 

 encouraged by that of some clinicians. The 

 student learns from his friends who have passed 

 on to their hospital work what little value physio- 

 logy possesses, as judged by the remarks made 

 by his clinical teachers. There are signs, how- 

 ever, that a change is taking place. The work 

 of physiologists in elucidating problems which 

 arose during the late war, such as the action of 

 poison gases, the regeneration of muscle and 

 nerve, wound-shock, and so on, had the effect of 

 demonstrating to many enlightened medical 

 officers the necessity of physiological science. 



On the side of the physiologists themselves it 

 is perhaps true to some extent, as the preface to 

 Prof. Macleod 's book states, that the laboratory 

 courses fail to give the student the conviction that 

 he is learning what will be of use to him in the 

 future. But this conviction is not an easy matter 

 to give, for the reason that the teacher, naturally 

 enough, is not regarded as an impartial judge 

 when he seeks to impress upon his students the 

 bearing of any particular lesson upon the inter- 

 pretation of disease. Prof. Macleod holds that 

 the chief remedy of the evil "lies partly in the 

 continuance of certain of the laboratory courses 

 into the clinical years, and partly in the study of 

 medical literature in which the application of 

 physiology in the practice of medicine is empha- 

 sised." For the latter of these objects the present 

 book is admirably fitted. The author intends it 

 as " an advanced text-book in physiology for those 

 about to enter upon their clinical instruction, and 

 at the same time a review for those of a maturer 

 clinical experience who may desire to seek the 

 physiological interpretation of diseased con- 

 ditions." 



The practice of continuing some course of 

 physiology during the clinical years is being 

 NO. 2616, VOL. 104] 



advocated in certain quarters at the present time. 

 A great difficulty is undoubtedly the enormous 

 bulk of clinical knowledge that the unfortunate 

 student has to learn. It would, perhaps, be a 

 valuable step in this direction if the laboratories 

 would arrange from time to time special lectures 

 or practical exercises on aspects of the subject 

 which happen to attract attention at the time, 

 say, for example, "acidosis" and hydrogen-ion 

 concentration at the present time. Suggestions 

 would be made by the clinical teachers. On the 

 other hand, this practice would not solve the 

 problem of giving the student a vital interest in 

 his laboratory work, and it has been suggested 

 that some opportunity might be arranged for the 

 student to see something of hospital work during 

 his physiological course. A note in Nature of 

 May 15 last states that Sir Edward Sharpey 

 Schafer objects to any systematic clinical in- 

 struction at this time. Doubtless with justice. 

 But might it not serve the purpose if an 

 occasional clinical demonstration, appropriate 

 to the physiological problem under discussion, 

 such as the taking of an electrocardiogram 

 in a case of heart disease in connection 

 with the treatment of electrical phenomena in 

 muscle, were given in the hospital? It would, at 

 all events, serve to show the student what he 

 must learn, and impress upon him how little he 

 knows. At the same time, much caution would 

 need to be exercised to avoid the fatal error of 

 limiting physiological teaching to what is obvi- 

 ously of immediate interest in clinical practice. 



The book before us does not claim to supersede 

 the general text-books, or to give instructions 

 for the performance of chemical tests and estima- 

 tions. These latter are only to be learned by 

 practice. Indeed, it would seem that the word 

 "biochemistry " in the title of the book might be 

 omitted, because the author himself states that 

 it treats biochemical knowledge from the view- 

 point of the physiologist. Biochemistry, in fact, 

 can scarcely be regarded as an independent science 

 in the sense that physiology is. Its separate 

 teaching and investigation are rather matters of 

 practical convenience, and, unless guarded against, 

 may lead to unfortunate results. Part of it is in- 

 cluded in physiology, animal and plant, while the 

 remaining part is a branch of organic chemistry. 



Certain aspects of physiology, such as the 

 phenomena of immunity and the details of re- 

 actions of the central nervous system, require 

 the space of special works. Some readers may 

 be inclined to think that the portion of Prof. 

 Macleod 's book devoted to the nervous system is 

 somewhat meagre in comparison with that occu- 

 pied in the usual text-books. It gives, however, 

 an excellent general account of the activities of 

 the nerve-centres, and we may call to mind that 

 a large part of the corresponding sections in many 

 text-books is occupied with pure anatomy. It is 

 curious that Prof. Macleod falls into the common 

 practice of describing the receptor organ for posi- 

 tion, the semicircular canals, under the head of 

 the cerebellum ; but this is possibly to be accounted 



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