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patient's system. Used occasionally, however, it is very beneficial -in fact in the above case it was indispensable, as it was the only drug that would give complete rest. Not as an aid but equally as important as any of the above treatment, is a proper observance of the ordinary laws of health. Bowels and kidneys should be kept active and the diet regulated in so far as it is possible.
A recent letter from the patient cited in this paper stated that all the old lesions have disappeared but that he still has, now and then, a little trouble in a new territory. In spite of these continued slight relapses no one knowing the Job like condition of the patient in the beginning of the treatment can for one moment doubt that ultimately he will be entirely relieved of his distressing affliction.
SECTION ON PATHOLOGY.
CHAIRMAN'S ADDRESS. THE ADVISABILITY OF A MORE DEFINITE COURSE OF INSTRUCTION IN PHYSICS IN THE MEDICAL CURRICULUM.
ALLEN J. SMITH, M. D.,
I would preface the matter of argument principally in mind in presenting this address by calling attention to a mental attitude very common in medical students, the aptness to regard the mere gaining of a diploma as the summum bonum of a course of study-a habit of thought which unfortunately is capable of being carried forward into the medical practice of the physician in viewing the possession of a diploma as justification of whatever of lack of skill and practical inefficiency may be exhibited in his professional life. There are, of course, many exceptions to the unfortunate truth of such an assertion; but in the minds of those accustomed to deal with large numbers of medical students the reality, however it may be regarded, of the first part of this proposition can scarcely fail of recognition; and it needs no long search in the great body of our profession to find ample evidence of the second. In fact there lies at the bottom of these mistaken purposes and opinions so much of common human nature, so many of the temptations of an artificial strenuosity of life which has never more than now prevailed in our country, that indeed it is matter for wonder that such faults of preparation and evasion of responsibility in action are not more numerous than they really seem.
Granted the truth of such statements, it naturally follows that in the mental processes of individuals of such type there should be exhibited the equally faulty wish and effort to obtain the desired
diploma and such license as it may afford at the least possible expenditure of energy, time and other valuable conisderations; and in whatever feature of preparation for medical practice there appears opportunity for evasion of difficulty, of conservation of mental effort and temporal and financial convenience, in that phase of the educational course of the individual such evasions are likely to be practiced. Naturally, too, in those subjects of the curriculum which do not on their face bear evidence of their immediate relation to future professional requirements are likely to be concentrated these attempts at evasion; and thus it comes to the untrained, unadvised or ill advised student of medicine that he should regard all his studies and exercises dealing with the so-called preliminary branches of medical training as unproductive, relatively valueless and undesirable, and justly to be neglected when opportunity obtains.
Of the branches of the medical curriculum or preparatory to it which in the experience of the writer are regarded by this type of student as veritable bugbears, physics, chemistry and general biology probably occupy the first rank, and probably among themselves stand in the order given. That there are reasons for the widely prevalent views of this sort among our classes is not, of course, to be doubted; and it is not at this time or in this paper my aim to recognize and discuss such reasons. Moreover, I do not wish in the present writing to attempt to show reason for insistence by medical instructors upon thoroughness of study in each of these branches of science by our classes. Both chemistry and biology seem in fair state to prove to even the most unthinking their absolute necessity to the really competent physician; and in fact need neither defense nor laudation. Chemistry at one time shared with anatomy in its all pervading dignity in the medical curriculum, but rather from its relations with the compounding of remedial agents than with either physiology or pathology. With the division of labor between physician and pharmaceutical chemist the older value of chemistry grew less and less in the appreciation of the first; and eventually had it not been for its ancient predomi
nance and the value of occasional applications in symptomatology (especially of the urinary diseases) it would doubtless with botany have been entirely relegated to the pharmaceutical curriculum as non-important to the medical man. But here, as in all human habits of thought, there is a pendulum swing now carrying back to its old prestige the study of chemistry, changed, it is true, in the type of its presentation and application, but each year recognized more and more in the form of physiological and pathological chemistry as one of the undeniable and main supports of our best medical knowledge. It is safe to say that within another generation physicians who are not also competent chemists will occupy just as little advanced position in the profession as do those now who are incompetent microscopists. The widespread interest in nature studies, reaching well down into the lower grades of our common schools, is sufficient assurance of the final position which general biology, at least as a preparatory branch, must bear for those who look forward to a life in medicine.
It is no great wonder that ancient and mediæval physicians were not also physicists as they were chemists when we recall the crude ideas and limitations of the general subject until comparatively modern times the really modern establishment of such basic ideas as the true relation of the earth in the solar system, the rotundity of the earth, the law of gravitation, the control of electricity, the mechanics of steam, the conservation and transformation of energy, the vibratory theory of force and a host of cognate matters, to say nothing of the discovery of the circulation of the blood, the cellular structure of the body and the cellular theory of disease.
In the manifold applications of the principles of physics in modern every-day human life men of a score of specialized professions are employed; yet nothing of the intricacy of construction and specialization of parts, of co-ordination of each to the whole. often inferred rather than clearly seen in the mechanism and function of the animal body, can be realized in the entire group of the engineering professions. There is not a single branch of the medical course of study, moreover, which does not in recognizable
way and degree call forth, directly or by analogy, the fixed principles of physics as clearly as in any engineering problem. The architectural ingenuity of man is barely comparable if at all to that shown in the adaptation of material for strength in the construction of bone, in the distribution and limitation of strain in the human skeleton; the principles of hydrostatics and hydronamies with the system of compensations witnessed in the circulations of the body are applied with more intricacy and exactness than seen in the highest engineering accomplishments in connection with any of the waterways of the globe; the development and co-ordination of gross and minute movements of the body and its parts exhibit a desideratum for mechanical engineers to be envied but not to be attained; the production and maintenance in uniformity of the body temperature in all the varying conditions of the body itself and its external relations in comparison with our best artificial means of heat production and regulation are as more than the work of the master to the work of the child; the complexity of the factors of physical and chemical processes operative in secretion and excretion renders the actual method almost a sealed book to the physiologist, but no man's machine is inscrutable to his fellows; the simplicity, convenience and effectiveness of the ocular and aural apparatus render our eyes and ears models to be approached but not attained by the ingenuity and skill of human inventors and mechanics; while the vast system of nervous paths and centers of the animal body may have an analogy in the most complex electrical arrangements of men, the whole world of electric systems compacted in one mass can scarcely rival the delicacy, multiplicity and infinite accomplishments of the nervous apparatus of one human body.
That a branch of science having such elaborate relations with the animal body in health and in disease should find little and often no definite representation in the medical curriculum is from the first serious thought in itself marvelous. Perhaps the complexity of its bearings in medicine and the profundity of its relations in life phenomena stand as a first excuse for this most significant