June 9, 1916] 



SCIENCE 



801 



for the clinical years, in planning which 

 every effort should be made to parcel out 

 the precious time, and to fill the periods, in 

 such a way as to give the best opportunities 

 possible, under the teachers and with the 

 equipment available. It is desirable that 

 the students shall gain a comprehensive 

 knovvledge of the principles of clinical medi- 

 cine and a systematic schooling in its prac- 

 tical-technical methods, both of which are 

 necessary for a medical career that shall be 

 satisfying to the man and of adequate serv- 

 ice to society. 



THE STUDENTS AS THEY ARRIVE IN THE CLINIC 



Fortunately, students now enter the clin- 

 ical years, or should do so if they take ad- 

 vantage of the opportunities offered them, 

 habituated to the method of science. They 

 have become familiar with the general prin- 

 ciples of the three great preliminary nat- 

 ural sciences (physics, chemistry and biol- 

 ogy) and of the three great preclinical med- 

 ical sciences (anatomy, physiology and 

 pathology), and to a certain extent they 

 have been trained in the actual use of the 

 practical-technical methods of investigation 

 employed in the laboratories of these six sci- 

 ences. By the time they have reached the 

 clinics, we may assume that they know 

 what the scientific method of inquiry is. 

 We may take it for granted they have 

 learned how problems are set and solved, 

 that they have acquired a feeling for accu- 

 rate observation, for the critical sifting of 

 facts, and for resorting to experiment to 

 perfect their observations. Students thus 

 trained will enjoy considerations of com- 

 parison and of regularity of sequence. 

 They will be acquainted with libraries and 

 will know how quickly to consult sources. 

 Many of them will have learned properly to 

 doubt when convincing evidence has not 

 been brought, whereas they will also, 

 through their experiences, have found that 



they may confidently act, after inquiry has 

 shown thai" action can be taken along lines 

 of sequences known to be invariable. 



The student's knowledge of man and of 

 his relations to the rest of nature should by 

 this time be fairly large. The student 

 knows man as a living, thinking, feeling, 

 acting social organism, very much like other 

 living beings, and yet differing strangely 

 from them. He has opened the body of man 

 after death and knows what his organs, 

 tissues and cells look like to the naked eye 

 and under the microscope, and he remem- 

 bers how these have all gradually grown 

 from the fused germ cells. He has had a 

 glimpse of the materials of which the cells 

 and juices of man's body are composed, has 

 isolated some of these materials and studied 

 their properties and origins. He has found 

 out that the materials in man are constantly 

 undergoing change, that with these changes, 

 synthetic and analytical, remarkable trans- 

 formations of energy go on, under special 

 conditions it is true (colloidal states; fer- 

 ment-activities, etc.), but always in obedi- 

 ence to the laws of the conservation of mass 

 and energy. He has been fascinated by the 

 study of processes known as irritability, 

 contraction, circulation, respiration, secre- 

 tion, digestion, absorption, metabolism, ex- 

 cretion and reproduction. He has seen how 

 these various functions can be modified by 

 environmental influences, and has come to 

 look on the body and mind of an organism 

 at any given moment as the direct resultant 

 of the energies in the germ cells and the 

 energies that have acted upon the organ- 

 isms from without from the time of germ- 

 cell fusion until that moment. He has come 

 to see that what we call "disease" is modi- 

 fication of structure and function beyond 

 certain limits, whereas maintenance of 

 structure and function within these limits 

 is designated as "health." 



In the bodies of men dead of long-con- 



