October 30, 1914] 



SCIENCE 



627 



vate practise. The senior assistant should 

 serve as adjunct to the head. It should be the 

 duties of these assistants, besides conducting 

 the routine work of the department with all 

 its ramifications, to take up successively, every 

 six months of these three years, special parts 

 of medicine for a special study, so that at the 

 end of the three years they would have ac- 

 quired an intimate knowledge of the entire 

 field of their department. They should also 

 acquire successfully a fair knowledge and 

 technique of all or most of the sciences allied 

 to medicine. They should follow closely the 

 new steps made in medicine and the allied 

 sciences and test the reliability and practical 

 applicability of new statements. I shall not 

 enter into further particulars of their duties, 

 which in the main should be guided by the 

 head of the department.* 



* The problem of research which ought to oc- 

 cupy the clinical departments, and the methods of 

 teaching which they ought to fallow are too ex- 

 tensive subjects to discuss them here. I wish, 

 nevertheless, to append here the following brief 

 remarks : 



1. Eeeent writers were emphatic in their state- 

 ments that diagnosis and therapeutics are the ex- 

 clusive fields for clinical research. When a 

 clinician begins to study pathological and physio- 

 logical problems it is time for him, they say, to 

 leave clinical medicine and become a pathologist 

 or a physiologist. This is a fundamental error 

 and an unfortunate misconception of the scope of 

 medicine. Diseases are experiments made by na- 

 ture which great clinicians ought to try to inter- 

 pret not merely by pressing them into facts, 

 views or classifications found or put up by 

 others, but also by original, broad views and 

 illuminating conceptions of their own, if they are 

 the brainy scientifically well-trained men which 

 they ought to be. Medicine had to wait long 

 for the appearance of clinicians like Graves, Ad- 

 dison, Gull and Kocher and Minkowsky to bring 

 to light new forms of diseases and to shed light 

 upon the normal function of apparently obscure 

 organs. If clinical medicine will attract real 

 brainy men who had a thorough training in the 

 methods of investigations in the adjoining exact 

 sciences and who would choose medicine as their 

 field of investigation, a flood of light would be 

 thrown in rapid order upon the nature and the 

 course of the functional processes in disease and 



When these scientific assistants have served 

 from eight to ten years, they will be in most 

 cases well qualified to investigate and teach 

 modern medicine from a scientific as well aS 

 from a practical point of view. That is the 

 new class of physicians, of which I spokfe 

 above, which should be created and from which 

 the new heads of clinical departments should 

 be chosen. If a number of high-grade med- 

 ical schools would accept this part of the 

 plan, in eight or ten years the country would 

 be provided with a group of a higher type of 

 clinicians. They will then work for the 

 further development of this new type and our 

 problem would find a permanent solution. 



The third group should consist, as stated 

 before, of professors, associate professors, 

 etc., who should teach practical medicine at 

 the bedside and for whom the teaching part, 

 may remain, as it is now, their secondary oc- 

 cupation, their primary occupation being pri- 

 vate practise. They should be appointed for 

 periods of five years and receive some re- 

 muneration. They should be selected from the 

 consultants and practitioners of the town 

 where they are recognized for their abil- 

 ity and efficiency. They should teach medi- 



in health. 2. Even in this, more scientific part of 

 the department, the practical education of the 

 students must be foremost in the mind of the 

 teacher. They should be taught, here, indeed, the 

 medicine aa it is known all over the world to- 

 day. But newer things ought to be tested at the 

 department for their reliableness and usefulness 

 and ought to be made handy and practical, be- 

 fore they are handed over to the students. All 

 students ought to be trained, in the first place, tp 

 become efficient practitioners. They will have to 

 see many patients in one day and will have to act 

 quickly and efficiently. New things appear daily; 

 some are very complicated and some have only a 

 temporary place in practical medicine. By load- 

 ing the minds of the average student (and prac- 

 titioner) indiscriminately with the "newest 

 things ' ' in medicine, we create there a haze which 

 interferes with the promptness of the practical 

 activity. Departments of medicine which will 

 seriously and in an unpreoecupied manner test 

 all new things before putting their stamp upon it, 

 will act as very meritorious clearing houses for 

 the practise of medicine. 



