338 



SCIENCE 



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



mals? In my opinion, the professor of medi- 

 cine must be prepared to study the symptoms 

 and the more superficial manifestations of 

 disease as seen in patients, as well as to carry 

 on complicated laboratory investigations. It 

 is chiefly throu^ the observations of patients 

 that clues are obtained as to the proper direc- 

 tion the more complicated studies should take. 

 It is true that much knowledge concerning dis- 

 ease has been obtained by bedside study alone. 

 In the present state of the science of medicine, 

 however, this method of study is now relatively 

 unproductive, and unless combined with more 

 elaborate and complicated methods is likely to 

 result chiefly in the elaboration of theories. 

 While theories are of importance in the study 

 of disease, just as they are in all scientific in- 

 quiry, they are of little value, until tested by 

 experiment. 



An additional reason why professors of medi- 

 cine should have a wide knowledge of disease 

 as it occurs in man is that they will themselves 

 have to be responsible for the care and treat- 

 ment of human beings sick of disease. It is 

 essential not only that no harm come to the 

 patients who are the objects of study but that 

 everything possible be done to bring every one 

 to a state of health, or as near that as possible. 



To avoid the necessity of having as teachers 

 of the science of medicine only such men as 

 have enjoyed a wide experience with disease in 

 all its forms and w'ho jwssess a knowledge of 

 the craft or art of practise, two makeshifts 

 have already been attempted. One expedient 

 has been to have men skilled in practical medi- 

 cine take over the actual care of the patients, 

 while the real studies are made by those who 

 have special knowledge of one of the sciences, 

 but who have no knowledge of practise, pos- 

 sibly no knowledge of disease. For instance, 

 the physiologist is invited into the clinic to 

 make observations or studies on certain cases. 

 In some instances this method has no doubt 

 led to advances in knowledge. It has distinct 

 limitations, however. Oftentinaes the facts ac- 

 cumulated in this way have very little immedi- 

 ate practical significance, whereas if the ob- 

 servations had been made by persons properly 

 trained in medicine, possibly only a slight 



modification in the methods employed would 

 have made the data obtained of great practical 

 value. Combined investigation sudh as this 

 has made little impression on the metliod of 

 study of disease or on the men who are con- 

 stantly engaged in the study or practise of 

 medicine. Indeed it has a blighting effect on 

 the scientific aspirations or scholarly ambitions 

 of the men in the department of medicine. 

 Sjaecialists in the various branches of science 

 can always be employed in the university 

 department of medicine to give advice, to 

 assist, and even to share in investigations, but 

 the department will reach its greatest effective- 

 ness only when the men engaged in teaching 

 medicine and in investigating disease have not 

 only a wide knowledge of disease as it occurs 

 in man, but special training in one or more of 

 the so-called contributing sciences as well. 



The second expedient is to establish in con- 

 nection witli the medical school a department 

 of experimental medicine, or research medi- 

 cine. This is neither sound in theory nor ef- 

 fective in practise. It is better than nothing, 

 but its establishment in a medical school means 

 that the teaching of medicine will go on in the 

 same old way, although a certain amount of 

 reputation may accrue to the school from the 

 fact that investigations are carried on within 

 its walls. The employment of this makeshift 

 has arisen from a disinclination to make any 

 fundamental change in the old order, w'hile 

 recognizing that change is necessary. It arises 

 from the recognition by those already engaged 

 in teaching that they are not prepared to adopt 

 new methods. These teachers do not object, 

 however, to grafting a new department on the 

 old one, so long as they personally retain their 

 old prestige and perquisites. In certain 

 schools, both in this country and in Europe, it 

 has been proposed to divide the medical school 

 clinics into several units, one or more of these 

 units to retain their old character, more or less 

 obviously, one or more to be organized into so- 

 called full-time or university clinics, tie latter 

 term being the one which I prefer because it 

 puts the emphasis upon the character of the 

 work. If certain schools want to try out this 

 method, one can not object. It is very doubt- 



