April 2, 1920] 



SCIENCE 



333 



tually dependent, medicine seems the most com- 

 plex of all. To know the abnormal we must 

 have knowledge of the normal. That is, what- 

 ever is known of structure of the human body 

 and the little that is known of function must 

 be available. In other words, knowledge con- 

 cerning anatomy and physiology mus.t be in 

 the possession of every student, and knowledge 

 of these sciences requires knowledge of chem- 

 istry and physics. These are weU-recognized 

 facts that need not be dwelled upon further. 



Are men available for such a department, as 

 teachers and students, men who are interested 

 in the study of disease and who desire 'to in- 

 crease the knowledge concerning disease with- 

 out any other material reward than the re- 

 wards of the student and scholar? Or has 

 scholarship gone out of fashion? Or is this 

 such an uninteresting subject that no men can 

 be found to undertake its study? As long as 

 men will study the stars with scientific meth- 

 ods, as long as men will study the stones with 

 scientific methods, men will be found to study 

 disease. The men are ready and waiting, the 

 opportunity only is needed. 



The second essential is laboratories. The 

 astronomer must have his telescope through 

 which to observe the stars; he naust also have 

 his chemical and his physical laboratories. 

 The student of medicine naust also have Ms 

 observatory, the hospital, and in this he should 

 also have laboratories — his laboratories — and 

 not be a guest or intruder in laboratories be- 

 longing to other scientific workers — chemists, 

 physiologists or others. It is just as impos- 

 sible tihat the science of medicine can be stud- 

 ied at the bedside alone, where only superficial 

 observation is possible, or that it can be 

 studied only in the laboratory, where disease 

 as it occurs in man is never present, as that 

 astronomy can reach its highest development 

 by observation through the telescope alone, or 

 by spectroscopic and chemical studies alone. 

 It is not uncommon that the contributing sci- 

 ences in the medical school are spoken of as 

 the laboratory brandhes and the medical di- 

 visions are spoken of as the clinical branches. 

 This in my opinion reflects the mistaken opin- 

 ion which prevails concerning the nature and 



proper methods of the study of medicine. For 

 the development and teaching of medicine, 

 laboratories are as essential as they are for the 

 study of physiology. But if they are to be 

 used, they must be in close proximity to the 

 wards, and they must be so arranged and or- 

 ganized that the work in the laboratories and 

 in the wards can go on simultaneously and 

 harmoniously in both. This conception of the 

 hospital, however, is rare even among those 

 who take the most advanced views concerning 

 medical education. I know of one university 

 hospital which is being planned before the 

 professors or staff that are to work in it have 

 been appointed. No architect or hospital sup- 

 erintendent can possibly accomplish this task. 

 For instance, the superintendent of a general 

 hospital must, of necessity, take an entirely 

 different view of a hospital from the one 

 which has been sketched. It would be just as 

 sensible to have a foreman of a machine shop 

 design a laboratory for the department of phys- 

 ics as to have a hospital superintendent design 

 a university hospital. In each case the super- 

 intendent or foreman might be of great assist- 

 ance and give useful suggestions, but he would 

 be as incapable of conceiving the purpose, and 

 therefore of working out the idea, in the one 

 case as in the other. 



It ean not be denied that it will be expen- 

 sive to install in each clinic of the hospital 

 well-equipped laboratories in which the varie- 

 ties of technique already developed in bacter- 

 iology, physiology and chemistry, can be used, 

 and in which entirely new methods may be de- 

 vised. This is essential, however, if the sci- 

 ence of medicine is to develop. In a given 

 clinic probably all the laboratories would not 

 at any one time be of equal importance. In 

 each clinic the development would probably be 

 mainly along special lines. If the division of 

 internal medicine, for instance, was a large 

 one, there might be several clinics or units, in 

 one of which the chief attention would be 

 given to one variety of disease, in another, to 

 another variety. In the study of human dis- 

 ease, however, much is gained in economy and 

 effectiveness if studies take not only one, but 

 several directions at the same time. The sub- 



