Volume 1

A system of medicine by eminent authorities in Great Britain, the United States and the Continent / edited by William Osler, assisted by Thomas McCrae.

Date:
1907-10
Catalogue details

Licence: In copyright

Credit: A system of medicine by eminent authorities in Great Britain, the United States and the Continent / edited by William Osler, assisted by Thomas McCrae. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    enon capable of utilization. Then comes an inventor who recognizes the possibility of its practical application. He may require the help of a skilled engineer who correlates the commercial and manufacturing conditions to be dealt with; and finally there is the capitalist who furnishes the means to make the invention of practical utility. In the science of medicine, to make efficient in every-day practice the new discoveries regarding the functions of the body and the phenomena of disease is a very difficult matter. There is much knowledge which cannot always be made helpful. It may add to the clearness of the clinical picture and ^enable us perhaps to recognize the nature and state of a disease without benefiting in the slightest the poor victim of it. A knowledge of the structure and of the functions of the motor paths may be of no use whatever in a case of complete destruction by a clot in the internal capsule; but in the very next case, one of syphilis of the brain, or in one of tumor of the cord, in the full utilization of this same knowledge may rest the issues of life and death. Just as in the mechanical sciences, it takes a combina- tion of human activities in several stages of effort to reap the benefit of . any discovery, so it is in medicine. The anatomist, the physiologist, the pathologist, the clinician, and the surgeon—in as many stages as from Faraday’s discovery of electromagnetic induction to the manufacture of a dynamo—all had to combine before a brain tumor could be removed successfully. Between Claude Bernard’s discovery of internal secretion and the cure of a case of myxoedema every department of medicine was taxed. To be exploited prematurely in practice is the common fate of all new scientific facts. Not content to wait for full knowledge, men hastily draw conclusions from imperfect data. Consider the dross wi h which the pure gold of Claude Bernard’s discovery has been mixed in an organotherapy often as irrational as that practised in the middle ages. VII. Intertwined as the subject is with the complicated sciences of physiology, organic chemistry, and physics, to make sol d contributions to clinical medicine we must systematize the work much more than has hitherto been possible. The trustees and managers of hospitals should appreciate more fully than they do at present the scientific needs of these institutions. To do justice to the patients, to carry out modern lines of treatment, indeed, to diagnosticate skilfully, require now the assistance of trained laboratory workers who should form part of the staff. It is impossible for any man, no matter how industrious, to keep abreast at all points with the chemical and bacteriological technique. Two important changes are necessary before hospitals are in a position to do the best possible work in clinical medicine: First, in many institutions the number of attending ])hysicians should be reduced. In small hospitals of a total capacity of one hundred and fifty beds the medical wards should be ])laced in charge of one man. In the larger city hospitals separate medical services should be arranged with from sixty to one hundred beds in each. The profession should learn to recognize the worker in internal medicine as a man who has to devote so much time to his studies that it is impossible for him to take general