800 



SCIENCE., 



[N. 9-. Vol. XLIII. No. 1119 



began their studies by using the method of 

 simple observation, but they have learned 

 how to make observation more accurate by 

 experiment so that internal medicine has 

 now become an elaborate experimental sci- 

 ence. The study of a single patient by 

 modem methods includes the making of a 

 very large number of experiments, that is, 

 of test procedures adopted on the chance of 

 their yielding to observation under espe- 

 cially controlled conditions definite infor- 

 mation that is not obtainable by simple non- 

 experimental observation. There is no 

 other science in which the technie of accu- 

 mulating facts is as extensive as in clinical 

 medicine, for its methods of examination 

 are based on and include the technical 

 methods of the preliminary natural sciences 

 and of all the intermediate, simpler pre- 

 clinical sciences. 



The end, or goal, of clinical medicine is 

 to understand the abnormal conditions that 

 may occur in the human organism in order 

 that physicians may act in a rational way to 

 cure them or to prevent them, instead of 

 being content to act in the blind and hap- 

 hazard way of the ignorant. The collection 

 of data, the arrangement of them accord- 

 ing to their similarities and sequences, the 

 epitomizing of them in the form of brief 

 symbols or generalizations such as syn- 

 dromes or disease complexes, while impor- 

 tant in themselves for the construction of 

 the science, are in reality only means to the 

 larger end of permitting suitable action for 

 the welfare of human beings that entrust 

 themselves to the care and supervision of 

 the medical profession. 



The great science of clinical medicine is, 

 therefore, subdivisible into two large parts : 

 (1) That dealing with the understanding of 

 exactly what is going on in the body and 

 mind of the patient and how it has come to 

 pass — the science of diagnosis; and (2) 

 that dealing with the fitting action to be 



taken to prevent the origin or extension of 

 abnormal processes, and, when possible, to 

 restore bodies and minds deviating from 

 normal function to a healthy state — the 

 science of prophylaxis and therapy. "We 

 endeavor to know in order to be able to 

 predict and to gain the power to control. 



The imperative need of the clinician to 

 know in order rationally to act has ac- 

 counted for the origin of the whole group of 

 the natural sciences. For, as every one 

 knows, physics, chemistry and biology had 

 their birth as a result of this need felt by 

 physicians; these sciences, and each mem- 

 ber of the whole group of the preclinical 

 medical sciences, began as daughters of the 

 clinic. In their infancy they were under 

 the fostering care of medicine; but they 

 have grown up into lusty adults, and now, 

 many of them, besides contributing hand- 

 somely to maternal support, are rendering 

 notable service to human efficiency and cul- 

 ture in domains far removed from clinical 

 medicine. I mention the primary relation- 

 ship, for some understanding of it is of 

 importance for the planning of clinical 

 teaching. 



THE NATURE OF CLINICAL TEACHING 



If the definition of clinical medicine that 

 I have given be accepted, the nature of the 

 teaching will be readily understood. It will 

 consist (1) in instructing the students re- 

 garding the organized body of knowledge 

 that has been accumulated concerning diag- 

 nosis and therapy (as already broadly de- 

 fined) ; and (2) in educating them in the 

 methods used in accumulating facts, in ar- 

 ranging them, in comparing them, in epi- 

 tomizing them, and in acting in a rational 

 way afterward — preventing, curing and 

 mitigating. 



On these general principles as a founda- 

 tion, the teachers of clinical medicine have 

 to construct a suitable concrete curriculum 



