Maech 17, 1916] 



SCIENCE 



377 



under consideration have gone effectively 

 into the fields of hygiene and preventive 

 medicine, although two have achieved dis- 

 tinction along these lines and one has a 

 world-wide reputation for his work in the 

 Far East and the Near East. 



The medicine of the future is certainly 

 to become more and more concerned with 

 the prevention of disease or with the pre- 

 vention of the spread of disease not only 

 in the community but in the individual and 

 relatively less concerned with its ultimate 

 ravages. Means must be devised for bring- 

 ing the student in contact with disease in its 

 incipieney both in the community and in 

 the individual and to give a "looking 

 forward" rather than a "looking back- 

 ward" point of view, opportunity to think 

 of disease in terms of its earliest beginnings 

 and gradual spx-ead, rather than merely to 

 deduce its course from its ravages. The 

 detection of the earliest symptoms requires 

 far more highly trained powers of clinical 

 observation and far more highly skilled 

 laboratory work than does the detection of 

 disease in its later stages. We now expect 

 tuberculosis to be detected before large cav- 

 ities have appeared or even before the spe- 

 cific bacilli are found in the sputum but 

 how many physicians can do so 1 The field 

 that lies between chemistry, bacteriology 

 and clinical medicine has been greatly 

 developed since the men we have been con- 

 sidering above received their undergradu- 

 ate clinical training and offers great help. 

 Modern roentgenology is also of help in 

 early diagnosis. But the undergraduates 

 of to-day wiU not get opportunity to have 

 practical experience in cultivating these 

 fields if abundant opportunity is not given 

 them for coming into contact with patients 

 in the earliest stages of disease. For this 

 consultation and diagnostic centers, such 

 as have been urged by insurance companies, 

 will have to be extensively established and 



placed at the disposal of our clinical teach- 

 ers. To encourage this the public will need 

 some education but there is a greater de- 

 mand for such centers, I think, than is 

 understood by the medical profession. The 

 need of preventive dentistry has long been 

 understood by the more intelligent classes 

 in this country. Recent developments have 

 shown that in the endeavor to save teeth 

 some dentists have succeeded to the detri- 

 ment of the general health of the patient 

 and have served to emphasize the fact that 

 specialists must cooperate for the ultimate 

 best results to the patient. 



Diagnostic centers used for medical 

 teaching will probably have to be supported 

 by public taxation or by endowments. Sim- 

 ilar centers should be open to those who can 

 afford to pay a moderate fee for the services 

 of a group of specialists. Few can afford, 

 or feel they can afford, to go to a series of 

 specialists and pay the fees necessary to 

 keep up a series of special establishments 

 unless disease is so far advanced that the 

 necessity seems imperative. With the de- 

 velopment of opportunities to study dis- 

 ease in its incipieney optimistic therapy 

 will more and more take the place of the 

 therapeutic nihilism that haunts the au- 

 topsy room. 



The development in Europe of social in- 

 surance and its beginnings in this country 

 will make the importance of preventive 

 medicine increasingly clear both to the or- 

 ganizers of industry and to industrial 

 workers. Somewhere in the training of 

 our students we must make them acquainted 

 with modern industrial problems so that as 

 physicians they may take a wise leadership 

 in at least the medical aspects of the indus- 

 trial reorganization which is taking place. 



One mistake frequently made should, I 

 think, be pointed out. No sharp line can 

 be drawn between preventive medicine, on 

 the one hand, and curative medicine, on 



