Duke University School of Medicine - Aesculapian Yearbook (Durham, NC)

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BIQCHEMISTRY Since the word biochemistry was coined, less than sixty years ago, the curricula of American medical schools have included biochemistry, physiological chemistry, medical chemistry, or pathological chemistry. The object, in so mistreating medical students, initially, was to impart a few technical skills which had immediate application in medical practice. Graduates of those cur- ricula found these skills useful and rarely questioned the point to biochemistry. The original impetus to biochemical research came from the problems of clinical medicine and biochemistry, as a discipline, grew up in medical schools. Much more recent has been the growth of biochemistry in its own right, i.e., an attempt to understand living systems in terms of the properties, organization and reactions of the chemicals of which they are composed. Meanwhile, the body of biochemical knowledge has approximately doubled each ten years and this growth continues at the same logarithmic pace. There is, therefore, about one hundred times as much to know about biochemistry as there was for medical students to consider at the opening of this century. To be sure, the language of biochemistry is no longer conhned to material presented to medical students during a few formal weeks in the first year of the curriculum. Histology and cytology must use this language, the phenomena with which physiologists, pharmacologists, pathologists, and microbiologists are concerned find ex- planation in biochemical terms-or fail to find explana- tion. The 2oo,ooo determinations performed annually by our Clinical Chemistry Laboratory are but a small token of the extent of clinical preoccupation with physio- logical chemistry. Nevertheless, it will be recognized that each year, our students are asked to consider a yet smaller fraction of that which is known about the human body in chemical terms. Thus, there are posed two allied questions. Which aspects of biochemistry should be presented to the neo- phyte medical student? And with which aspects of biochemistry should the faculty of biochemistry concern itself in our research laboratories? Our philosophy in this regard is based on several factors: ij Not only is our clinical faculty alert to the clinical applications of biochemistry, many are quite qu courant with recent developments in fundamental biochemistry. Hence, they teach and practice transfer medicine, medicine which is firmly based on sophisticated application of the basic medical sciences. 25 Whereas biochemical thinking becomes ever more important to medical practice, it is no longer essential that medical students struggle with biochemical laboratory skills which are best left to the combined competence of both the iron maidens and F U 4'Nvvqq, i . . ..,,, DR. HANDLER the charming young ladies who operate them in the clinical chemistry laboratory. gl Many of our clinical faculty engage in research which is addressed to deeper biochemical understanding of clinical problems. In so doing, they have accepted the challenges which pre- viously had been the concern of the practicing bio- chemist. .Q Medicine, as a profession which should rest upon an ever expanding base, must look to the not very distant future. For my part, I find intolerable a vision of the year 2,ooo, when the American population will have doubled, if this must also mean twice as many hos- pital beds, rest homes, sanitaria, nurses, doctors, etc., etc. It is imperative that we learn to deal more successfully with the dread diseases before the population explosion overwhelms us. And we can only hope to do so if, almost tomorrow, we acquire a much more profound understanding of human biology. Hence, it is a considered judgment that medical stu- dents are entitled to an opportunity to understand life in the most fundamental terms and that this will form the basis of medical practice tomorrow. Anatomy must be brought to its ultimate-the architecture of the macro- molecules of which we are made. And physiology must be understood as a cooperative behavior of these mole- cules. If this be done adequately, then, for example, will the physiologists be in position to discuss contraction, the immunologists to consider antibodies, the pharma- cologists to worry with cholinergic drugs, and the pathol- ogists to address themselves to neoplastic processes, all with intelligence and understanding which are impos- sible at this time. Achievement of this goal will require that students be offered the most rigorous treatment of biochemistry possible, and that they be prepared, in advance, to do so. It does not, however, require that all students be forced to repeat in the laboratory the evidence for bio- sixteen

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ATOM Y Technical competence is the lirst requisite and schol- arly distinction is the first ohligation of the department. The second requisite of the department is the capacity for the dissemination of knowledge that reaches the young men and women aspiring to a career in medical service. The third requisite is the creation of the type of intellectual environment which is maximally condu- cive for learning. Our ohiective in the teaching ol anatomy is to give the student maximal assistance in his acquisition ol knowledge. The kind of knowledge he needs to acquire involves the memorization of many anatomical details as well as understanding the suhiect matter of anatomy and its relation to all of his other learning experiences as a medical student and to his career in medicine. The prohlem involved in the teaching of anatomy concerns supplying the students a large quanity of diverse resource material. This resource material includes ca- pahle teachers plus recorded material such as hooks, drawings, models and specimens. For practical reasons, these resource materials and the numher of teachers are limited, and thus, some compromises are made. It he' comes necessary to introduce some large-group teaching: namely, lectures, motion pictures, and television pre- sentations. I Dix. TALMADGE L. PEELE Wpi '9'. DR. lhfliililsllzii As a part of their total study ol' the suhiect matter in anatomy, the students are made aware of the fact that this teaching is going on in an environment which in- cludes continuing research. Ample opportunities are given the students to participate in this research. Iosaifu M.-xitkma, Pii.D. Cflizzirlmzzz of the D6'pt1I'fl?26lZf fumes B. Duke I'r0fe5.v0r at isi isf, J '- ' ,. .. .1 MN Ms ' x 1.3 fin Q. . . atassiy - x , , - pw mi . si .- f xlkgsiikge. gig? It Q ' W w -ss TNCNTQ' .X ' , . at H .s X .s we ,zzsw . ,sw-5.' - s V- .- my wa . ,1-.:: :,..,.c. V ,-2 :.,.-.ce s -sm.-..bvs,. X , S Q 1 -X t DR. DL'NC,kN C. Hiariilaiuxcrox fifteen

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chemical concepts. Such experience, in the future, may well he limited to students who voluntarily so request. By the same token, in their research lahoratories, the hiochemical faculty should-and dowaddress themselves to questions which have no immediate application in medicine, hut the answers to which must. ol necessity, form the hasis for medical practice tomorrow: I-low do enzymes work? Wlizit is an antihody? llow do genes work? What factors make for the harmonious, integrated flow of metaholism which characterizes the normal cell? I-low is the potential energy of foodstufls transduced into the accomplishment of mechanical, elec- trical, osmotic, or chemical work? How are the various kinds of macromolecules made? Wlizit are the specihc functions of diverse suhcellular organelles and how are these constructed? What is the molecular basis for cellular dillerentiationF ls there a molecular liasis lor memory? These are the grand questions. The health ol the American people tomorrow will depend upon our success in linding the answers. lt is these questions which underlie the research programs ol' the faculty ol the Department ol' liiochemistry and it is the current state ol' the answers to these questions which properly constitutes the hasis for the course in hiochemistry which we oller to our students. Hopefully. we shall soon he ahle also to provide, to those students so desiring, a much more intensive experience in hiochemistry as part of their medical education. PHILIP I-I.xxn1,ER, PIID. Cfmirzmzn of lfze Dcfprzrtnzcnt lunzes B. Duke l'r0fes,v0r vu . Du. HENRY li,-XMIN DR. NIARY Biiitrsniaim Dia. WILLIQXKI LYNN .fC'l!C l1fC'C'71