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SCIENCE 



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



portant does it seem to become. An analogy 

 may be drawn to the state of aSairs lately ex- 

 isting in botany when the chief attention was 

 given to the classification and naming of 

 plants. "We now know that this is only a part, 

 and a relatively unimportant part, of the sci- 

 ence of botany. A man may stiU be a great 

 botanist even though on walking through a 

 field he may not be able to name con-ectly 

 every plant or tree which he meets. While 

 diagnosis in medicine is important, its position 

 in the educational scheme is misplaced. In- 

 stead of placing it at the 'beginning of the 

 study of medicine, it should come later, after a 

 knowledge of the more fundamental principles 

 of medical science has been acquired. If a 

 student knows much about a few of the com- 

 mon, more important forms of disease, the rec- 

 ognition of the rare forms will be relatively 

 easy. 



Another function of the practising physician 

 is the care of the sick and the relief of pain, 

 mental and physical. Part of this labor is 

 borne by the nurse, but the physician must 

 bear the larger share, and if he is able to 

 analyze disturbances in function, he is often- 

 times able to bring relief even though he can 

 not cure. 



One of the chief efforts of the physician is 

 to establish a feeling of confidence in the 

 patient and in the family, and to relieve 

 anxiety. The success of this effort dex)ends 

 largely on personality, but consciousness of 

 real knowledge is a most important factor con- 

 tributing to such an inspiring personal rela- 

 tionship. 



In our present system the student learns 

 less about therapeutics than about any other 

 feature of disease. For a system of education 

 that claims to be essentially practical, it ob- 

 tains most impractical results. However much 

 we may rail at the ineffectiveness of treatment 

 — ^and the best practitioners are accustomed to 

 do this — there are at least a few therapeutic 

 measures that are of great effectiveness and a 

 few diseases over which the physician has abso- 

 lute control. Yet how little does the student 

 actually learn during his student days of the 

 really practical methods of employing these 



measures! How ill prepared he is to meet 

 actual conditions, unless the procedures to be 

 employed are of the greatest simplicity! 



By present methods, therefore, students are 

 not well trained, even in the elements of prac- 

 tise, except as concerns diagnosis. They 

 should be better trained for practise. 



In order to judge of the probable effect of 

 the proposed plan, not only on the development 

 of the science of medicine, but on the practise 

 of medicine as well, let us sketch briefly the 

 proposed organization of the division of in- 

 ternal medicine and the nature of the work 

 which it is intended should be carried on. 



The number of clinics which compose the 

 division of internal medicine will depend upon 

 the funds and men available and upon the size 

 of the university or school. Each clinic, how- 

 ever, should have, let us say, a hundred or a 

 hundred and fifty beds, its own independent 

 laboratories equipped for the prosecution of 

 chemical, physical, physiological and bacterio- 

 logical studies, as well as laboratories for 

 pathological anatomy and facilities for animal 

 experimentation. The number of students ad- 

 mitted should be limited ; these students should 

 have had a general college, scientific training, 

 preferably with specialization in chemistry, 

 physics or biology. Before admission to the 

 department of medicine, they should have stud- 

 ied anatomy, physiology and bacteriology. 

 This work may have been done in any univer- 

 sity. The custom of studying one subject in 

 one university, and another subject in another 

 university, shoidd be encouraged. This would 

 result in bringing into the department meth- 

 ods and points of view derived from many 

 sources. 



The teachers should be carefully chosen 

 young men who have had a good training in 

 clinical methods and who are also well 

 grounded in at least one of the contributing 

 sciences, some in chemistry, some in physiol- 

 ogy and so forth. Before appointment, they 

 should have given evidence of ability not only 

 to teach but also to aid in extending the boun- 

 daries of medical knowledge. In this depart- 

 ment brief courses should be given in the meth- 

 ods for observing and recording the more 



