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SCIENCE 



[N. S. Vol. LI. No. 1318 



ing little coherence and no general guiding 

 principle of organization or function. In many 

 soliools some of these branches have becsome 

 much more important than the parent stem, 

 both as r^ards resources and as regards the 

 characrter of the work which is undertaken. 

 There are departments of surgery, of ortho- 

 pedics, of psychiatry, of genito-urinary dis- 

 eases, of gastro-intestinal diseases, of pedia- 

 trics, of ophthalmology, of dermatology, of 

 laryngology, of endocrinology, of elecerothera- 

 peutics, and so forth, and so on. Some of these 

 departments, owing to the skill and prominence 

 of the professors in practise, have acquired 

 buildings and equipment of greater extent than 

 the educational importance of the subjects war- 

 rants, and of far greater extent than the scien- 

 tific development of these subjects justifies. 



It is true that one additional circumstance 

 has contributed to this extensive partitioning of 

 the department of medicine. Most universities 

 and medical schools have been compelled to 

 employ general hospitals for teaching purposes, 

 hospitals which were primarily planned and 

 organized to care for the sick poor. ISTow, 

 within limits, the larger the general hospital, 

 the more efficiently and economically it can 

 be conducted, and in the medical and surgical 

 treatment of large numbers of persons, a high 

 degree of specialization has been found to be 

 most efFective. It does not follow, however, 

 that the same principles which should apply to 

 the organization of a general hospital should 

 also apply to the organization of a clinic de- 

 signed primarily for investigation and teach- 

 ing, merely because both have one function in 

 common, namely, the care and treatment of the 

 sick. The university department of medicine 

 has an added function, the investigation of 

 disease and the teaching of students, and if a 

 general hospital is to serve this added func- 

 tion, its organization must be modified accord- 

 ingly. 



In the efforts which have been made to im- 

 prove the teaching of medicine, not infre- 

 quently that division of medicine having to do 

 with the study of so-called internal diseases 

 has received the least and last consideration. 

 These diseases, however, because of the suffer- 



ing and loss of life which result from them, 

 are of far more practical importance than any 

 other group of diseases. Of much more sig- 

 nificance than this, at least from the educa- 

 tional standpoint, is the fact that the diseases 

 of internal medicine are the ones which are 

 most susceptible to scientific study, and thus 

 far they ' are the principal diseases to which 

 modern scientific methods of investigation have 

 been applied. They are therefore the diseases 

 with which the student of medicine should be 

 chiefly concerned during his earlier years. It 

 is in the study of these diseases that the stu- 

 dent should develop his perspective and should 

 obtain a knowledge of the methods which 

 should be employed in the study of all other 

 diseases. For this reason, in writing the fol- 

 lowing discussion of the department of medi- 

 cine as a whole, I have had the division of in- 

 ternal medicine chiefly in mind, for this di- 

 vision should be a pattern for all the others. 



Bearing in mind our definition of medicine 

 land the conception of the boundaries of the 

 department of medicine which we have adopted, 

 let us consider what we mean by a university 

 department of medicine. It is a department 

 designed for the purpose of studying and in- 

 vestigating diseases, of accumulating and dis- 

 tributing the existing knowledge concerning 

 disease and of contributing to the extension of 

 this knowledge. 



What is needed to create a university de- 

 partment? Exactly the same materials that 

 are required in every other scientific depart- 

 ment of the university — men, laboratories and 

 books; and the most important of these is men. 

 By men I mean students, of various grades. 

 Some, the more advanced, we call teachers; 

 the others, less developed, we call students ; but 

 they must all be constantly acquiring knowl- 

 edge or the department is a failure. More- 

 over, the essential requirements for admission 

 must be the same for teachers and students, 

 though differing in degree. They must all 

 have the desire for acquiring knowledge, they 

 must have the desire to add to knowledge, and 

 they must have the training and ability to 

 enable them to carry out their 'desires. While 

 all science is complex and all sciences are mu- 



