April 28, 1922] 



SCIENCE 



439 



Let us proceed with the central thought; 

 greater men in medicine through greater liberty 

 in medical education. A medical school is 

 built upon the same general foundation as any 

 other institution. Purpose, products, materials, 

 and methods form the corner stones. 



The purpose of the medical school is to train 

 men in the application of scientific methods 

 to the prevention, alleviation, and cure of dis- 

 ease, and to advance medical knowledge in its 

 broadest sense. 



The products of medical schools may be con- 

 sidered as belonging to three principal groups : 

 the practitioners, the investigators, and the 

 teachers. A survey of the medical profession 

 at large shows that its eminent men usually 

 may be placed in one or the other of these 

 gi'oups; sometimes in two, but rarely in three. 

 The gi'oup of practitioners comprises those 

 whose primary interests are in the alleviation 

 and cure of disease. The group of investiga- 

 tors includes those whose deepest interests are 

 in the causation and prevention of disease. The 

 group of teachers contains those whose princi- 

 pal aims are the dissemination of the methods 

 adopted and the results achieved by the practi- 

 tioners and the investigators. Lister, Pasteur, 

 and Osier typify the groups. 



A few decades ago, the country demanded 

 and the schools furnished, for the most part, 

 but one type of practitioner, and that type was 

 the all-round practitioner. He was obliged to 

 know something of medicine, surgery, and ob- 

 stetrics, together with dentistry and pliarmacy. 

 In addition to these, he was expected to show 

 proficiency as a veterinarian. The conditions 

 of to-day are so different, that the all-round 

 practitioner of to-day would have been a spe- 

 cialist fifty years ago. The cries from the 

 country for general practitioners are heard far 

 and wide but are less and less heeded by the 

 young gi-aduate. A doctor who has had mod- 

 ern training in laboratories and clinics with 

 apparatus and libraries and contact with pro- 

 gressive men, is quite unwilling to leave all 

 these. Moreover he can not come up to dear 

 old Dr. Brown to whom physioguonijf revealed 

 more than modern laboratory methods; who 

 did many a successful major opersiion on the 

 kitchen table, and who thought nursing and a 



controlled environment entirely superfluous. 

 The ambitious young doctor of yesterday, fol- 

 lowing the advice and example of his success- 

 ful seniors, went forth to do an all-round prac- 

 tice for a number of years before entering 

 upon the study of a specialty. Away from 

 libraries, laboratories, clinics and stimulating 

 colleagues, he found little growth or expan- 

 sion, beyond that indicated by adipose tissue. 

 The ambitious young doctor of to-day who 

 contemplates a career as a specialist dispenses 

 with this hibernating period of two or three 

 years and seeks instead the live atmosphere of 

 the hospital, an assistantship to the master, or 

 a fellowship in some one of our great founda- 

 tions. The rural districts and small towns will 

 he obliged to adopt something of the same 

 methods that they long ago adopted in secur- 

 ing churches, schools, and factories — they will 

 lie ©bliged to build and equip hospitals if they 

 hope to obtain modern medical service. With 

 the hospital comes the staff which, in turn, 

 forms the basis of the group clinic. Instead 

 of the general practitioner making a complete 

 diagnosis, there is a group of collaborating 

 clinicians, each of whom is an expert in his 

 particular field. The rapid development of the 

 group clinic is creating a situation which must 

 be recognized both by the profession and the 

 schools. 



The practitioner of the future, either gen- 

 eral or special, not only must measvu-e up in 

 self-reliance, responsibility, and judgment to 

 the practitioner of the past, but also must be 

 better trained and more thoroughly imbued 

 with the investigative spirit. 



Each patient presents a problem, the solu- 

 tion of which is more difficult than that in 

 almost any other field of science. While every 

 medical problem must be approached through 

 the avenues of physics, chemistry, or biology, 

 the physician is often baffled at the very be- 

 ginning of his work by the fact that he is 

 unable to determine which will aid him most. 

 Often he finds that no one of these sciences 

 will solve the problem but that all are involved. 

 Phj-sics may explain the mechanism of joints 

 and muscles; it may aid us in the intei-preta- 

 tion of the effects of light, heat, electricity, 

 osmosis, pressure, on living tissues, but it does 



