Januakt 14, 1916] 



SCIENCE 



55 



1. Investigation of the problems of cer- 

 tain chronic diseases. 



2. Cooperative efforts with other depart- 

 ments, particularly the department of med- 

 icine. 



3. Special elective courses of instruction 

 for medical students, and 



4. Opportunities for research offered to 

 physicians and others. 



These four lines of effort have been the 

 chief object of the department and upon 

 the success of these must rest opinion con- 

 cerning the value of such a department to 

 the medical school or the community. 



1. nSrVESTIGATION 



From the point of view of the investi- 

 gator the field of the chronic diseases is the 

 most difficult of approach in the entire ter- 

 ritory of medicine and it is for this reason 

 that our exact knowledge of these diseases 

 progresses so slowly. The very slight 

 knowledge we have concerning their etiol- 

 ogy, the insidious nature of their onset, 

 their slow progress, the frequent involve- 

 ment of several organs in a general degen- 

 erative process, and the difficulty of repro- 

 ducing pure types of chronic lesions ex- 

 perimentally, render impossible the bril- 

 liant achievements which have characterized 

 the attack on the acute infectious diseases 

 by the methods of bacteriology and im- 

 munology. Progress must depend on the 

 slower methods of physiology and chem- 

 istry as used in experimental and clinical 

 studies. The immediate problem in a 

 given disease is to understand the gradual 

 and progressive changes in physiology 

 which a particular type of organic lesion 

 produces rather than to discover its ex- 

 act etiology. Naturally etiology and of 

 course therapeusis, looking to amelioration 

 of a chronic diseased condition, are the 

 ultimate objects of researches in this field, 

 but at present the best form of attack seems 



to be that designed to explain pathological 

 physiology and especially the physiology 

 or chemistry of the characteristic crises and 

 complications, as, for example, the edema, 

 uremia and hypertension of nephritis, the 

 acidosis and coma of diabetes, the exacerba- 

 tions of gout and so forth. The investiga- 

 tion of individuals, the subjects of chronic 

 disease, by means of metabolism studies, 

 functional tests and instruments of pre- 

 cision, as those applied to the eardio-vas- 

 cular system, must constitute an important 

 phase of work in this field. This must, 

 necessarily, be supplemented by exper- 

 iments on animals which have for their 

 object the reproduction of lesions chronic 

 in nature which may then be studied by 

 the methods of physiology and chemistry, 

 or, if this is not always possible, by the 

 reproduction of isolated phenomena, or 

 analogous symptoms or complications. 

 Chronic disease and its phenomena can not 

 always be imitated perfectly by exper- 

 iment, but the imperfect experiment may 

 nevertheless throw some light on the 

 phenomena of a particular disease. Fi- 

 nally, a department devoted to this field of 

 disease must be prepared to test out new 

 functional and other tests and to apply im- 

 mediately the discoveries of physics, phys- 

 iology and chemistry to both the exper- 

 imental and clinical study of chronic dis- 

 ease. 



Whether or not this plan of approaching 

 the study of the chronic diseases is the best 

 that could be conceived, it remains the 

 plan adopted by the department under con- 

 sideration. The principal lines of investi- 

 gation which have been followed during the 

 past five years have been those concerning 

 (1) diseases of the kidney and (2) the 

 spleen in relation to anemia and hemolytic 

 jaundice. The first of these studies was 

 undertaken largely on account of the great 

 importance of nephritis as the common dis- 



