May 19, 1916] 



SCIENCE 



695 



a practitioner to preside over the clinical 

 laboratory to-day, and at the same time to 

 do justice to his responsibilities as a physi- 

 cian. 



Chemistry as related to the practise of 

 medicine thirty years ago played a rela- 

 tively small part in the medical curriculum. 

 It was mainly restricted to its application 

 to the study of urine, and those studies were 

 for the most part of a simple character. 

 To-day the chemical problems involved in 

 the studies of human metabolism and used 

 in the art of diagnosis are numerous and 

 complicated, and are steadily increasing. 

 No well-equipped medical clinic can exist 

 without a department of chemistry, which 

 should be presided over by a man of train- 

 ing and experience, capable of conducting 

 and directing research and of overlooking 

 the necessary studies of a variety of prob- 

 lems which arise in the wards of the hos- 

 pital, for, as has been pointed out, no school 

 of medicine can fulfil its mission to-day 

 without intimate association with an ade- 

 quate hospital. It is not easily conceivable 

 that the director of the chemical laboratory 

 could find time for medical activities out- 

 side the clinic. 



The older methods of physical examina- 

 tion, so called, although mastered only by 

 practise and experience, were yet mechan- 

 ically simple. To-day, however, for the ex- 

 ploration of the human body and its activ- 

 ities, there are employed physical proce- 

 dures which involve the use of instruments 

 of great delicacy and demand a highly 

 specialized technique. And subdepart- 

 ments of radiology and electrocardiography 

 each )with its laboratory and its director, 

 are necessary constituents of the modern 

 department of medicine. 



The medical clinic should also have a spe- 

 cial department of bacteriology and serol- 

 ogy, another subdepartment the direction 

 of which demands much of the time of an 



experienced student. Of these laboratories 

 also the director should be one who is able 

 to organize, conduct and stimulate research. 



Again, there should be in association with 

 every medical clinic a department of phys- 

 ical therapy for the study and application 

 of mechanical, hydro- and electro-thera- 

 peutical methods; and especially for the 

 teaching of massage and of general physical 

 training. Such a department might, it is 

 true, be under the combined control of affili- 

 ated medical and surgical clinics, but some 

 of the responsibility for its organization and 

 direction should lie with the chief of the 

 medical service. 



It has been said that the directors of these 

 subdepartments could hardly be expected to 

 give any essential part of their time to the 

 practise of medicine. Are they therefore 

 wholly to be removed fj-om the care of the 

 sick? Is the department of medicine to 

 have under its control a number of subde- 

 partments presided over by so-called 

 "pure" bacteriologists, physiologists, phys- 

 icists, chemists — men who are entirely re- 

 moved from direct responsibility for the 

 care of the sick? Far from it. 



In the ideally arranged department of 

 medicine, all of these men should have 

 clinical duties and responsibilities — duties 

 and responsibilities which, in a hospital, 

 may be systematized. And in the properly 

 organized department of medicine, although 

 many of its members may in a sense be 

 specialists, yet none will fail to acquire a 

 wide general medical experience. 



Let us now for a minute reconsider the 

 problems which confront the director of a 

 department of medicine to-day. The 

 teacher of thirty years ago followed a rela- 

 tively simple routine. The chief of a mod- 

 ern medical clinic finds himself the head of 

 a complicated machine, involving the ap- 

 pointment of a large number of salaried as- 

 sistants, the manipulation of a consider- 



