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

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PATHOLOGT Pathology has been defined as the science which deals with the causes, mechanisms of development and effects of disease. It is the bridge between basic medical science and clinical practice, and the study of Pathology pro- vides the student with his first experiences in his life long study-disease. At a medical school such as Duke much of the departmental effort is devoted to the teach- ing of Pathology to medical students. In addition, be- cause of the large amount of surgical and autopsy ma- terial available at Duke, it is possible to maintain a very active graduate training program. Young physicians who choose to specialize in Pathology or who wish to receive further grounding in the basic fundaments of disease before entering a clinical speciality spend from one to four years in the department as a member of the house staff. At this stage the training is predominantly by the apprentice approach with close association between the resident and senior members of the department. Usually after a period of four years of such training, the resident is eligible for certification by the American Board of Pathology. During this period of training the residents in pathology gain teaching experience so that the majority of those who complete this training con- tinue to hold an academic position in pathology either at Duke or some other medical school. Those residents who go into a clinical specialty after a shorter period of graduate training in Pathology have the security of a fuller and more precise knowledge of disease. Harvey Cushing once wrote that 'iapprenticeship in the patho- logical laboratories always has been and always will be the only way to reach the very top either for the surgeon or physicianf' and William Osler claimed that suc- cessful knowledge of the infinite variations of disease can be obtained by a prolonged study of morbid anat- omy. The Practitioner of Pathology specializes in the prac- tice of laboratory medicine for the purpose of providing physicians and surgeons with the scientific information they must have in order to treat their patients most efficiently and successfully. The hospital pathologist is responsible for the identification of the disease process in the surgical specimen removed at operation and for the final diagnosis at the autopsy table. ln many hos- pitals he also may supervise the laboratories of clinical chemistry, hematology, and bacteriology as well as the blood bank. The pathologist works in close cooperation with the patientls physician in arriving at a diagnosis and assisting with the patient's treatment by furnishing lab- oratory tests which aid in determining effectiveness of the patient's therapy. No specialist is called upon for consul- DR. KINNEY tation by others as frequently as is the hospital patholo- gist. All universities have as one of their chief responsi- bilities the development, dissemination, and application of new knowledge in the various fields of learning. For this reason, the Department of Pathology at Duke Uni- versity maintains an extensive research program. Every effort is made to provide opportunities for students and residents to participate in basic research programs and to develop their own skills and interests in the field. This gives the imaginative young doctor a chance to ex- plore unknown areas of medicine. Research offers a major challenge to the physician who desires the excite- ment of discovery for experimental medicine is one of the truly genuine adventures. TI-Ioxras D, KINNEY, M.D. Clzrzirman of the Department DR. KLAVINS DR. KAUFBIAN .S'EZ!6'71ff3671

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department, the selection of the areas covered by the Laboratories involved decisions regarding the most promising frontiers in the two disciplines. Research in the Department can be viewed as directed toward two such frontiers. First, the goal of much of the work is to increase our understanding of the molecular basis of the energy transformations which underlie fundamental physiological processes such as muscular contraction, nerve conduction, active transport, and cell division. The second frontier involves the analysis of complex inte- grated physiological functions such as the mechanics of respiration, the activity of the brain, etc., with the use of modern analogue and digital computer techniques. Within the Division of Physiology the following Labora- tories are in being: Laboratory of Cellular Neurophysi- ology fChief, I. W. Moorej, Laboratory of Integrative Neurophysiology fChief, G. Somjenj, Laboratory of Muscle Physiology CChief, P. Horowiczj, Laboratory of Molecular Physiology CChief, I. Blumj, Laboratory of Cellular Endocrinology fChief, I. Kostyoj, Laboratory of Cardiopulmonary Physiology fChief, I. Salzanoj, and the Laboratory of Cellular Transport Processes fChief, D. C. Tostesonj. The Division of Pharmacology QI-lead, E. M. Renkiny presently comprises the Laboratory of Biochemical Pharmacology QChief, E. A. Iohnsonj and the Laboratory of Circulatory Pharmacology QChief, E. M. Renkinj. The Department's view of the role of physiology and pharmacology in medicine is well expressed by the fol- lowing remarks of Claude Bernard in his brilliant treatise An Introduction to the Study of Experimental Medicine cI865,I mln the empirical period of medicine, which must doubtless still be greatly prolonged, physi- ology and therapeutics could advance separately, for as neither of them was well established, they were not DR. RENKIN vv if.. Q- I -21.3 1 :.QE5' 4' ff M, 1' ' ij!! ? , 'f ...- - -. starr H . . 4 . A f4?v v'I, -.:':55:f5'3?.2f:,.z..2: 5 , , f nf. , . -, :--.. M.: + -,144 ,--:,-r-,.:-:...:.:- -vm-. ..-z..--...aa s w DR. BERNHEHXI called upon mutually to support each other in medical practice. But this cannot be so when medicine becomes scientific: it must then be founded on physiology. Since science can be established only by the comparative method, knowledge of pathological or abnormal condi- tions cannot be gained Without previous knowledge of normal states, just as the therapeutic action of abnormal agents, or medicines, on the organism cannot be scien- tifically understood without first studying the physi- ological action of the normal agents which maintain the phenomena of life. But scientific medicine, like the other sciences, can be established only by experimental means, i.e., by direct and rigorous application of reasoning to the facts fur- nished us by observation and experiment. Considered in itself, the experimental method is nothing but reason- ing by whose help we methodically submit our ideas to experience,-the experience of facts. ln the introductory courses, we seek not only to inform first and second year students about the most im- portant principles and facts in physiology and phar- macology, but also to provide an opportunity to practice the experimental method in Bernard's sense of sub- mitting ideas to experience, e.g., the experience of others as reported in scientific journals. An effort is made to reveal the relevance of physiology and pharmacology to clinical medicine by conducting clinical-physiological conferences in the introductory courses and by participat- ing in certain special courses for residents. To this end, the faculty of clinical physiologists and pharmacologists who hold appointments in a clinical department as well as in this Department has been very valuable. DANIEL C. TOS'fESON, M.D. Chairman of the Department sixteen

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MI CRGBIOLGGT Microbiology, like Pathology, is both a basic medical science and a clinical service. The department not only teaches basic knowledge and techniques of the discipline but in addition describes to the student the important clinical aspects of infections caused by viruses, bacteria, parasites and fungi and maintains several clinical diag- nostic laboratories which aid in the diagnosis and treat- ment of the various infectious diseases found in the Duke Medical Center. Besides medical students, Microbiology teaches nurses, technicians and graduate students, and most of the departmental staff are faculty members of both the Duke Medical School and the Duke Graduate School. Within the department are a number of research lab- oratories which are, for the most part, supported by grants from the United States Public Health Service. Dr. Gross,s genetics laboratory is concerned with problems related to gene structure and function. Dr. Willett's bacterial metabolism studies have been concerned with biochemical mechanisms of antituberculous drugs. Dr. Osterhout's virus research has studied the problem of latent herpes simplex infections. Dr. Overman,s virus laboratory has investigated by electron microscopy the mechanisms of virus particle entry into cells. Dr. D. T. Smith has studied the tuberculin skin reaction to various mycobacterial antigens. Dr. Conant's laboratory aids in the identification of fungi sent to it from all over the world. Dr. Eiring is concerned with the organization of the student laboratories as well as virus and rickettsial diagnostic studies for the clinical laboratories. Drs. Amos, Day, Metzgar, Zmijewski and Buckley comprise the Immunology group whose primary research interest is in organ transplantation. NORBIAN F. CONANT, PH.D. Chairman of the Department lame: B. Duke Professor IMM U OLQGT Immunology was, until relatively recently a rather stable and circumscribed subject dealing largely with the antibody response to various substances, mainly bacterial or serum protein. Within the last few years there have been a series of developments which have led to the de- velopment of immunology as a major science. To some extent immunological techniques are used by biochem- ists, microbiologists, geneticists and many others, in re- turn, the study of immunology now itself intrudes into DR. CONANT these subjects and uses their knowledge and techniques for a more thorough study of the basic facets of im- munity. To some extent this was due to the questioning of Burnet and others as to the actual mechanism of the initiation of immunity, but it also grew from studies of Medawar and his colleagues on the activities of the lymphoid cells and from realization that allergic and im- munologic processes were closely related and more com- plex than had been previously suspected. Duke University has recently established a division of Immunology with the expanded Department of Microbiology and Immunology. The division includes four full time faculty members: Drs. D. Bernard Amos, Eugene D. Day, Richard S. Metzgar and Chester Zmijewski, as well as a number of post doctoral fellows, visiting scientists and has provision for graduate and medical students. The major emphasis of the division fC0ntz'nzzed on page :ggi D. BERNARD AMOS eigh teen