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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    practice, and in a way he is a specialist, in the broad sense of the term, like the surgeon. The development of clinical medicine is retarded by the present system of appointing general practitioners, often the busiest and most successful men, in charge of the wards. Nowadays only under exceptional circumstances does a man of energy and jjcrseverance evolve from these surroundings into a thoroughly trained clinical investi- gator. In saying this I do not forget that from these conditions aro.se the very men who have contributed most to medicine in America, men of the stamp of W. W. Gerhard, Austin Flint, Da Costa and Pcjjper. But the times are changing, and 1 know that I express the feelings of hospital physicians themselves when I state that a reorganization is urgently demanded along the lines here indicated. Not only in the larger cities, but in towns of from fifty to one hundred thousand inhabitants the well-equipped medical clinic is the most urgent need of the profession. Secondly, the internal organization of the hospitals must be changed to meet the new demands. A larger number of house physicians is required, who should be graded so that raw, inexperienced graduates should not be put at once in full charge of patients. A clinical laboratory with chemical and bacteriological assistants should be provided for each service, or, in the smaller hospitals, one would suffice for all departments. This need, now generally recognized for hospitals connected with medical schools, is of equal importance in the smaller hospitals. An example of what organization can do in this direction is afforded by the remarkable clinic which has been built up in Rochester, Minnesota, by the Mayo brothers, who have made that little town a world-known resort for both physicians and surgeons, and whose success has been due as much to their careful attention to the laboratory side of their work as to the technique for which they have become so famous. Lastly, my earnest hope is that this series of volumes may be of service in that education which each one of us has to work out for himself in practice. Set on the right path in the schools it should not be difficult for a man to keep in touch with the advances of science, and to give his patients the benefit of all those accessories which are so important in the recog- nition and successful treatment of disease. Just as the clinical laboratory is a necessity to the hospital physician engaged in the solution of the most advanced ])roblems in medicine, .so the private laboratory is indispensable in the every-day work of the bu.sy practitioner. Urine analysis, blood counts, sputum e.xaminations, chemical analysis of .stomach contents, all these should be done at home: at first, by the physician himself, while not too busy; later by an assistant. This may .seem to be asking a great deal in the heavy routine of the day, but it is not asking too much, and it will be done more and more when we send out our students familiar by long prac- tice with the u.se of the micro.scope and other instruments of precision. It makes the practice of meflicine of absorbing interest when one feels he is approaching the study of a ca.se ecpiippcfl with modern methods, and it is the neglect of these accessories that makes so many men fall into slip- shod habits of diagnosis, and still more careless methods of treatment. Asked the single most powerful weapon today in the hands of the pro- fession against quackery of all sorts, I would answer: the little laboratory room attached to the office of the general practitioner. Nor is it asking