April 2, 1920] 



SCIENCE 



335 



kind of training that will enable him to dis- 

 criminate between the true and the false. 



A further detail of the organization of the 

 depai'tment of medicine concerns its relation 

 to the department of pathological anatomy. 

 From what has been previously stated, it is ob- 

 vious that the deipartment of pathological 

 anatomy should constitiite an integral part of 

 the department of medicine. The laboratory 

 of pathological anatomy should be closely con- 

 nected geographically, as well as in organiza- 

 tion, with each one of the clinics. It should 

 not be a block or a mile away from the clinics, 

 or even in an isolated building on the hospital 

 grounds. It should he physically a part of the 

 department of medicine. There would be a 

 great advantage in having at all times at least 

 one assistant from each clinic acting as a 

 member of the pathological staff. Each of 

 these assistants should be engaged, under the 

 direction of the professor of pathological anat- 

 omy, in studying and teaching the anatomical 

 changes resulting from the special group of 

 diseases which is being studied in the clinic 

 which he represents. On the other hand, the 

 professor of pathological anatomy should be a 

 member of the administrative stafi of the de- 

 partment of medicine. The effect of such an 

 association as I have described would not only 

 be of great educational value, but I believe that 

 it would bring about a " new birth " of patho- 

 logical anatomy. 



The objection will probably be raised by 

 some that, although the introduction of the 

 proposed principles and plans into the depart- 

 ment of medicine might result in a greater 

 and more rapid accumulation of knowledge 

 concerning disease, it would have no immedi- 

 ate effect upon society at large or upon the 

 practise of medicine. If this were so, the 

 value of the plan might be quesitioned, though 

 I would not go so far as to deny its value even 

 under these circumstances. I assume, however, 

 that one of the most important functions of 

 the department of medicine must be to train 

 men in order that they may become capable 

 practitioners of medicine. Now the practise 

 of medicine, or the practical application of the 



science of medicine, may be considered to be 

 directed in several lines : 



1. Prevention of disease or decay. 



2. Diagnosis, care of the sick and alleviation 

 of pain. 



3. Cure of disease. 



At the present time the first function of the 

 practising physician is exercised in a very 

 minor degree. The medical schools take little 

 cognizance of it. Therefore we may omit dis- 

 cussion of it here, though in my opinion it is 

 the most important of the three, and the de- 

 partment I have in mind would exert great 

 effort upon the development and extension of 

 this function. 



The second important function of the prac- 

 tising physician is to make diagnoses, that is, 

 to bring the particular symptoms from which 

 a patient suffers and the most striking fea- 

 tures of his malady into relation with a group 

 of symptoms and signs which have already 

 been described and given the name of a disease. 

 This is of great importance from the stand- 

 point both of prognosis and treatment. Orig- 

 inally the classification of disease was empir- 

 ical; later it was founded, in part on an ana- 

 tomical, in part on an etiological basis, and in 

 part merely on the presence of some striking 

 feature. There is much that is empirical, 

 superficial and traditional in this subject; 

 nevertheless, in the present state of the science, 

 it is important. The physician, therefore, must 

 be trained in the methods of diagnosis. He 

 must be trained in the method of Zadig. 

 There are many tricks, short cuts and simpli- 

 fied methods in diagnosis with which the prac- 

 tising physician should be familiar, though 

 they have not an essential place in the funda- 

 mental science of medicine. 



At present, however, the chief efforts of the 

 department of internal medicine in our medical 

 schools are directed towards the cultivation of 

 diagnostic skill in the student. Much time is 

 frequently devoted to the recognition of some 

 rare disease, even though only a half dozen 

 cases have ever been recognized and although 

 nothing essential about the disease itself is 

 known. Indeed the more unusual the special 

 group of signs and symptoms, the more im- 



