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SCIENCE 



[N. S. Vol. XXX. No. 761 



wants to do its part in throwing additional 

 light upon the causes and treatment of dis- 

 ease. Now the first of these functions is 

 not so very difficult of performance. 

 Under conditions as they are teachers of 

 medicine and surgery can be obtained who 

 will give to students the best methods of 

 diagnosis and treatment, and so far as the 

 limited time permite will send them out 

 into the world prepared to develop into 

 competent practitioners of medicine. There 

 can be no doubt, however, that this func- 

 tion would be performed more satisfacto- 

 rily from the standpoint of the school if an 

 arrangement could be made whereby the 

 professors gave more time to the work of 

 instruction. But the provisions made for 

 the advancement of knowledge by investi- 

 gation are not so satisfactory as they 

 should be. Whatever may be the position 

 of a proprietary school in this particular, 

 the university school surely can not be sat- 

 isfied with playing the part of a mere re- 

 flector of knowledge. The spirit of investi- 

 gation is wide-spread in medicine at the 

 present day. AVe have the highest kinds of 

 hope that the methods of science may be 

 applied with success to the study of dis- 

 eases of all kind. There has been an ex- 

 traordinary increase in our knowledge of 

 infectious diseases, and resulting therefrom 

 a really wonderful improvement in our con- 

 trol of the conditions threatening public 

 and private health. All this we owe di- 

 rectly to the use of the laboratory method 

 of investigation. A similar victory may be 

 gained over the numerous constitutional 

 and nutritional diseases whose causes are at 

 present hidden in the secrets of the body 

 metabolism, but to accomplish this desirable 

 end, or at least to accelerate its accomplish- 

 ment, we must organize more satisfactorily 

 our means of investigation. Shall we limit 

 our investigations to the laboratories of 

 the medical sciences and to special insti- 



tutes, or shall we extend them into the clin- 

 ical branches? It is almost useless to put 

 such a question. Investigation by experi- 

 mental methods has spread into the clinical 

 departments, and a great increase in the 

 development of this phase of research ac- 

 tivity may be regarded as inevitable. The 

 point that has been raised and which I 

 should like to emphasize is that our present 

 system is not well adapted to promote this 

 kind of work. Our custom is to appoint as 

 heads of these departments men who are 

 engaged in the practise of medicine, and it 

 is perfectly evident that if these men give 

 themselves unreservedly to the demands of 

 practise their efficiency as teachers and in- 

 vestigators will be seriously impaired, in- 

 deed, in the latter particular, will prob- 

 ably be destroyed altogether. To attain the 

 combination of those qualities which are 

 most desirable from the view-point of the 

 university one of two changes should be 

 made. Either there should be a definite 

 limitation placed on the time given to out- 

 side practise, so that opportunity of a 

 known extent may remain for teaching and 

 research, or these positions should be 

 placed squarely on a university basis, the 

 practise of the incumbents being limited to 

 the hospital and dispensary and the labora- 

 tories attached to them. The two proposi- 

 tions bear to each other somewhat the re- 

 lation of a half loaf to a whole loaf. 

 Neither of these principles is in force to- 

 day, so far as I know, in any of our better 

 schools. Investigations that bear directly 

 on the problems of practical medicine are 

 carried on in the laboratories of the med- 

 ical sciences, in the special institutes, and 

 by the younger men in the clinical depart- 

 ments who are preparing themselves for 

 higher positions. We possess also a certain 

 small number of professors of medicine and 

 surgery who, in spite of abundant oppor- 

 tunities offered to enlarge their incomes. 



