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SCIENCE 



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



jeots studied are so complex that it is wasteful 

 to confine an investigation to a single narrow 

 path. Thus in studying a group of patients 

 suffering from an infectious disease, it is fre- 

 quently important that they be studied not only 

 from the standpoint of etiology, in which the 

 chief work will be done in the bacteriological 

 laboratory of the clinic, but it may be of great 

 importance that, at the same time, alterations 

 in metabolism and disturbances in function of 

 the circulatory and respiratory systems be in- 

 vestigated, in which case the laboratory and 

 technique of physiology or possibly of physics 

 will be required, and on the same patients 

 chemical studies of the blood or excretions may 

 be valuable, all of which must be carried out 

 in the special laboratories of the clinic. By 

 carrying out all these procedures on the same 

 patients, not only is expense saved, but each 

 observation gains much in importance by being 

 supplemented by the others. 

 , In the university department of medicine 

 there should not only be facilities for studying 

 disease as it occurs in man, but there should 

 also be facilities for carrying out experimental 

 studies on animals. In many cases only by 

 animal experimentation can the suggestions 

 obtained from detailed observations on patients 

 be confirmed or disproved. 



"With regard to the library, little need be 

 said here except that it must be alive, not dead. 



The above is my conception in brief of the 

 essentials of a department of medicine in a 

 university. Grant a central concept such as 

 this on which to build, and it will not be diffi- 

 cult to elaborate the details, at least it will not 

 be impossible. For instance, let us consider 

 the number and kinds of the divisions into 

 which any given department of medicine shall 

 be divided, or in other words, the kinds of dis- 

 eases for the study of which special clinics 

 shall be provided. There can be little question 

 that the diseases isi>oken of as surgical (be- 

 cause operative technique is employed in treat- 

 ing them) are of such great importance and 

 the technique of their therapy has become so 

 specialized, that one or more clinics of the de- 

 partment should be devoted to the study of 

 these diseases. This does not mean, however. 



that the methods employed in studying these 

 diseases diiler from those used in studying any 

 other group of diseases. Exophthalmic goiter 

 is the same disease whether we treat it by re- 

 moval of the thyroid or by rest and drugs. 

 Whether we call the professor who studies 

 especially those diseases in which the chief 

 therapeutic procedures are operative, a pro- 

 fessor of surgery or a professor of medicine, is 

 unimportant so far as the principle is con- 

 cerned. His methods should be those of the 

 professor of medicine as I have sketched him, 

 and the surgical clinic should be exactly like 

 the medical clinic with the addition of facili- 

 ties for employing complicated operative pro- 

 cedures. The same principle should also 

 govern the organization of the division of 

 pediatrics or any other one of the divisions into 

 which it is decided to separate the department 

 of medicine. 



, The exact number of divisions in any de- 

 partment of medicine will have to depend upon 

 the men and resources available and upon the 

 contemporary state of knowledge concerning 

 the various groups of diseases, and upon the 

 immediate importance of increasing this 

 knowledge. There seems to be no good reason, 

 however, for dividing the department of medi- 

 cine into a great number of divisions and sub- 

 divisions. Indeed, from the educational stand- 

 point very great disadvantages are inherent in 

 this method, owing to the scattering of interest 

 which results. The efficiency of a department 

 of medicine does not depend upon the number 

 of its clinics or instructors, or upon the va- 

 riety of subjects treated. The attempt to pre- 

 sent to the student every known fact and 

 theory concerning disease and to exhibit to 

 him examples of every known form of disease 

 only causes him to become confused and be- 

 wildered. What is much needed at present in 

 medical education is the elimination of the 

 unessential and the untrue. No student can 

 be expected to learn all that has been thought 

 about disease and all the theories that have 

 been proposed. He should have, however, op- 

 portunities to learn what is actually known 

 about imiKjrtant diseases and to receive the 



