August 11, 1922] 



SCIENCE 



151 



method of reseai-eh. It may here be made 

 clear that no school expects all of its students 

 to undertake scientific investigation; indeed 

 only a part and perhaps but a small part of 

 the student body either want to or are fitted 

 for it, but our schools must hold in research 

 those who are to be the next generation of 

 teachers. Thus the extension of the full-time 

 scheme throughout the medical training means 

 putting the entire medical training into the 

 hands of professional educators. 



The full-time scheme in clinical medicine 

 substitutes research to be associated with teach- 

 ing, instead of the practice of medicine. The 

 progress of medicine of the past thirty years 

 has brought us face to face with something 

 quite new, namely, with preventive medicine 

 as a i-eality instead of a dream. We need no 

 longer say diseases may disappear, but dis- 

 eases are disappearing. It is this fact that 

 calls for something really profound in the 

 reorganization of medical education. When 

 I began the study of medicine twenty-six years 

 ago, we learned clinical medicine mainly in 

 the typhoid wards. In the fall nearl5' every- 

 thing on the medical side gave way to typhoid; 

 now our students hardly see it. The most 

 vivid memories of my year of internship are of 

 typhoid tubs and the elaborate reasons for 

 believing in them; our students will now carry 

 away the impression of the value of sanita- 

 tion and the efficacy of typhoid vaccine. In 

 China, last summer, the contrast between pre- 

 ventive and palliative medicine became clearer 

 to my mind than ever before. I was hearing 

 of deaths from malaria and discussions as to 

 whether it was wiser for the traveler to take 

 small preventive doses of quinine or not, some 

 saying that the subsequent treatment in case of 

 infection was less effective if these preliminary 

 doses had been taken. I knew that in reality 

 only certain places at home had really elim- 

 inated malaria; but I also knew that our own 

 department of clinical microscopy was having 

 a difficult time to get enough blood infected 

 with malarial parasites to teach our students 

 the characteristics of the organism. With our 

 present knowledge it is easy to see that the 

 better way for China to deal with malaria is 

 to get rid of mosquitoes rather than to import 



quinine, but it is just as clear that until there 

 is money enough and enough of a civic organ- 

 ization in China to undertake sanitation, the 

 palliative treatment of each case of malaria is 

 the only feasible plan. At least it is easy to 

 see which type of work has the greater ultimate 

 value, the research which shows that the mos- 

 quito is the intermediate host of malaria and 

 shows how to eliminate the disease or the dis- 

 covery of the effect of quinine and the treat- 

 ment of each case. Such a contrast by no 

 means disparages the skill of clinical diagnosis 

 and treatment; it is quite clear that palliative 

 medicine must remain as the measure of the 

 failure and ignorance of preventive medicine. 

 In the full-time scheme as applied to clinical 

 medicine, we recognize that preventive medi- 

 cine has so far advanced that we can demand 

 that the few leaders of medical education shall 

 have as their major intellectual interest the 

 growth of scientifie medicine. The actual deal- 

 ing with the sick is an ancient and honorable 

 profession; but the science of preventive medi- 

 cine is a profession on a still higher plane and 

 it is now legitimate to ask that those who are 

 teaching in a profession which is thus changing 

 shall themselves contribute to that change. The 

 research which brings new methods is of great- 

 er ultimate value than the immediate practical 

 application of our present knowledge. 



It must again be emphasized that practical 

 applications of knowledge are in no way to be 

 despised. The practise of medicine must be 

 palliative but I should here like to pay tribute 

 to the pi-ogress of curative medicine. There 

 has developed on the clinical side of modern 

 medicine a degree of expert skill in diagnosis 

 of which I believe many workers on the purely 

 scientific side are unaware and underestimate. 

 Our students must acquire this skill; there are 

 certain parts of the medical training where I 

 believe our students should be really expert 

 when they are graduated, namely: in the tech- 

 nique of clinical microscopy, in the methods of 

 medical and surgical diagnosis, and in the 

 aseptic technique of modern surgery. In their 

 attitude toward curative medicine, those who 

 are working on the scientifie side should keep 

 clearly in mind that the amount of curative 

 medicine necessary is the measure of the defi- 



