January 9, 1914] 



SCIENCE 



59 



learns it when he attends so-ealled quiz 

 classes in medicine — he is very likely to 

 lose all of his scientific attitude towards 

 the management of disease. He comes to 

 think of diagnosis as being nothing more 

 than an endeavor to find the text-book name 

 for the disease under which the grouping 

 of symptoms which he elicits happens to 

 fall, and he loses sight of the fact that the 

 symptoms are the outcome of disturbed 

 function or functions, and that they may 

 vary very much indeed in different indi- 

 viduals, according to the degree of physi- 

 ological disturbance which the lesion cre- 

 ates. He becomes a student of symptoms 

 rather than an investigator of the condi- 

 tions which are their cause. After all, 

 text-books of medicine are intended only as 

 rough guides for the classification of dis- 

 ease, and it is fatal to efficiency in medical 

 training if this fact is not constantly borne 

 home on the student. He must be 

 taught to study and treat each patient 

 as an individual problem, and just as 

 he has learned in the practical course in 

 physiology that the same experimental con- 

 dition may lead to different reactions in 

 different animals, so must he expect to find 

 among different patients the same want of 

 uniformity in the symptoms which are pro- 

 duced by the same lesion. The student 

 must be constantly reminded that the prac- 

 tise of medicine is in its merest infancy, 

 and that its growth depends almost entirely 

 on the degree to which it will be possible 

 to apply the accurate methods of physi- 

 ology and experimental medicine to its in- 

 vestigation. In the past, the development 

 of knowledge of the disease of the circulat- 

 ing system, for example, has depended upon 

 the use of the simple methods of ausculta- 

 tion and percussion; at the present it is 

 bound up with the use of the electrocar- 

 diogram, the polysphygmogram and the 

 skiagram, and in the future it will un- 



doubtedly be largely dependent upon meth- 

 ods which will be born and cradled in the 

 physiological laboratories. Every man 

 trained in the right atmosphere becomes a 

 potential contributor to the advancement of 

 clinical knowledge. 



In order to carry out these ideals in the 

 teaching of medicine, it is necessary to pro- 

 vide courses such as experimental pharma- 

 cology and so-called experimental medi- 

 cine, in which the more purely physiolog- 

 ical experiment is modified so as to show 

 how its results can be used in the investi- 

 gation of disease. By giving pharmacol- 

 ogy in the third year of the medical 

 course, and experimental medicine in the 

 fourth, the difficulty that the student will 

 disregard the scientific aspect of medical 

 practise is much lessened. 



In this discussion it should be pointed 

 out that the term physiology is employed 

 in the broad sense under which it was de- 

 fined at the outset, that is: it includes the 

 physical, the purely biological and the 

 chemical phenomena of life. 



J. J. E. MACLEOD. 



Western Eeserve University 



ACCIDENTS IN COAL MINES 



The lack of comparable and accurate sta- 

 tistics of coal-mine accidents in the United 

 States has led the Bureau of Mines to collect 

 such data, and the results of these investiga- 

 tions have been compiled by Mr. F. W. Horton, 

 in Bulletin No. 69, entitled " Coal Mine Acci- 

 dents in the United States and Foreign Coun- 

 tries," which has just been issued. This report 

 shows that during 1912, 2,360 men were killed 

 in the coal mines in the United States as com- 

 pared with 2,719 for 1911, and that the fatality 

 rate was lowered from 3.73 in 1911, to 3.15 per 

 1,000 men employed in 1912. The report con- 

 tains statistical information concerning the 

 production, the number of men employed and 

 the number of men killed in each state since 

 1896. From 1896 to 1907 the number of men 



