June 9, 1916] 



SCIENCE 



807 



pathologic processes. Thus, in the first 

 place, the student will be taught how to 

 make accurate examinations of the senses 

 and of the sense organs (cutaneous, deep, 

 gustatory, olfactory, acoustic, vestibular 

 and visual) ; of the motor functions and 

 the reflexes ; of the coordinating powers ; of 

 the capacity for speech, for writing and for 

 other complex movements; of the func- 

 tions of the smooth muscle and of the se- 

 creting glands; of the sphincters, and of 

 the trophic functions. In this connection, 

 certain applications of anthropologic meth- 

 ods of measurement may be practised, as 

 well as the technic of roentgenologic exami- 

 nations of the nervous system, skull and 

 spine ; that of lumbar puncture ; and that 

 of diagnostic electrical examinations of the 

 muscles and nerves. The student will be 

 taught at this time, too, how to examine the 

 mental state of a patient, paying attention 

 not only to the patient's consciousness as a 

 whole, but also to the special powers of at- 

 tention, of apperception, and of identifica- 

 tion, to the affective life of the patient as 

 revealed by his feelings, emotions and 

 moods, and to his conative functions, often 

 called "the will," and judged of by the 

 person's behavior or conduct. 



The second part of this instruction in 

 clinical neurology will involve a review of 

 the architecture of the nervous system and 

 of the physiology of the several neuron 

 systems (centripetal, centrifugal and as- 

 sociative), in as far as these subjects can 

 be applied to localizing diagnosis; the stu- 

 dent will quickly see the reasons for de- 

 ciding whether the lesions present, or the 

 pathologic processes going on, concern the 

 peripheral nerves, the spinal cord, the 

 medulla, pons or cerebellum, the mid-brain, 

 the interbrain or the end-brain, and whether 

 they are focal or diffuse, single or multiple. 



And in the third part of the neurologic 

 work, instruction will be given in the prin- 



ciples on which the diagnosis of the nature 

 of a nervous disease is arrived at. The dif- 

 ference between the so-called "organic" 

 and "functional" diseases of the nervous 

 system will be discussed, and the student 

 will learn the criteria for recognizing 

 whether a given organic disease has been 

 due to disturbances of development, of the 

 blood supply, or of the nutrition; to toxic 

 or infectious processes causing degenera- 

 tion or inflammation ; to trauma ; to para- 

 sitic invasion; or to tumor growth. 



Instruction in methods should include 

 finally the procedures used for the clinical 

 study of metabolism. After a brief review 

 of the physiology of metabolism, the stu- 

 dent should be taught the requirements of 

 systematic metabolic studies. Though 

 there may not be time to do actual practical 

 work in the quantitative chemical analysis 

 of foods and excreta, the organization of a 

 modern metabolic study will be illustrated 

 and the students will become acquainted 

 with the manner of preparing a patient for 

 such a study, with the periods of observa- 

 tion required, with the doctrine of "bal- 

 ance, ' ' and with the preliminary tests that 

 may have to be made of assimilation, di- 

 gestion and absorption. After this intro- 

 duction, the methods of determining in man 

 the metabolism of proteins, nucleins and 

 purins, carbohydrates, fats, water, mineral 

 substances and vitamines will be demon- 

 strated. The different forms of apparatus 

 for direct and indirect calorimetry will be 

 described and the use of at least some of 

 them actually demonstrated. Such a pre- 

 liminary discipline in the practical-tech- 

 nical methods of metabolic study I regard 

 as essential if the students are later in their 

 course to proceed to the study of states of 

 under-nutrition and over-nutrition, of the 

 several amino-acid diatheses, of diabetes 

 mellitus, and of gout, armed with the 

 knowledge and technic that the science of 



