802 



SCIENCE 



[N. S. Vol. XLIII. No. 1119 



tinued disease, he has studied the coarser 

 and finer changes in the organs and in the 

 cells, and has contrasted them with the 

 findings in a healthy man of the same age 

 killed 'by accident. His teachers have 

 shown him specimens illustrating transi- 

 tion stages 'between coarser structural 

 changes and the beginnings of organic dis- 

 ease. Studies of pathologic chemistry have 

 convinced him that, in the absence of 

 changes in form recognizable by our pres- 

 ent methods, deviations of the chemical 

 composition from that of health can often 

 be found. Among the many deleterious 

 environmental influences, he has discovered 

 bacterial and parasitic invasion to be espe- 

 cially important; he has studied these bac- 

 teria and parasites, and has used them to 

 produce diseases in animals for experi- 

 mental comparative study. He has ob- 

 served striking differences in susceptibility 

 to noxEe among these experimental animals, 

 and has seen that this susceptibility is capa- 

 ble of artificial modification. His studies 

 in immunology and in pharmacology have 

 convinced him that man can often intervene 

 in a strictly rational way favorably to 

 modify the processes that go on in an 

 organism. 



During this whole period of preliminary 

 and preclinical study, the student's back- 

 ground has been gradually and extensively 

 elaborated. His studies in each successive 

 science have been, to a certain extent, a re- 

 view of the sciences preceding. Bepetitio 

 est mater studiorum. And yet, even more 

 important for the clinic than the actual 

 content of the student's mind as regards the 

 ancillary sciences is the long discipline that 

 his mind has had in observing and reflecting 

 — I mean, the development in it of a perma- 

 nent scientific habit. 



MEDICAIj wards ; AMBULATOEIUM ; THE INSTI- 

 TUTE FOR CLINICAL MEDICINE 



The teaching of clinical medicine as a 

 science demands conditions very different 



from those that formerly existed, and very 

 different from those that are even at pres- 

 ent available in any of our medical schools, 

 though some schools have been fortunate 

 enough to secure conditions that approach 

 what is needed. Briefly stated, the condi- 

 tions that a department of clinical medi- 

 cine should control include (1) a medical 

 clinic to which may be admitted a sufficient 

 number of patients suffering from all vari- 

 eties of both acute and chronic internal dis- 

 eases (infectious, parasitic, respiratory, cir- 

 culatory, hemopoietic, digestive, urogenital, 

 locomotory, nervous, metabolic), with ward 

 laboratories for routine application of the 

 commoner laboratory methods; (2) a med- 

 ical dispensary or ambulatorium, to which 

 a large number of patients, who, for vari- 

 ous reasons, do not enter the stationary 

 clinic, apply for diagnosis and treatment, 

 and in connection with which there are 

 large and small teaching rooms, a labo- 

 ratory and also quarters in which the vari- 

 ous special branches of internal medicine 

 apply their special methods of examination ; 

 (3) a large clinical institute adjacent to 

 the wards and dispensary, containing (a) a 

 clinical amphitheater for lectures, clinics 

 and lantern-slide demonstrations to a whole 

 class; (&) a general clinical laboratory in 

 which systematic courses in clinical chem- 

 istry, clinical microscopy, etc., can be given 

 to the whole class at the beginning of their 

 clinical work; (c) a series of smaller labo- 

 ratories especially equipped for routine 

 work in clinical bacteriology, clinical immu- 

 nology, clinical physiology, etc. ; (d) other 

 laboratories for advanced investigative 

 work in metabolism, for the study of mate- 

 rials from clinical autopsies, and for 

 animal experimentation; (e) a "heart sta- 

 tion" in which sphygmographic and elec- 

 trocardiographic and other graphic regis- 

 trations can be made; (/) a capacious 

 roentgenologic laboratory with complete 

 outfit for modern roentgenography and 



