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

Page 23 text:

PSTCHIATPCY The Department of Psychiatry has a three-fold pur- pose. lt is dithcult to assign priorities, but they may be stated as follows: the preparation and training of students of medicine to practice better the art and science of medicine through an understanding of normal and ab- normal behaviorg the training of the resident to practice his specialty. and through the demonstration of psychi- atric practice by the faculty coupled with a vigorous, broad and imaginative research program contribute to that body of information which will better equip society to deal with the physically and mentally ill. A century ago, the mentally sick were herded into large hospitals and segregated away from the main stream of life. Treatment in the main was custodial. With the advent of a liberal movement. the psychodynamically oriented psychiatrist focused upon the individual patient and his intrapsychic and interpersonal life. The one-to- one interaction with the emotionally disturbed patient brought hope and the focus turned away from the dis- turbed group and onto the disturbed individual. The second world war demonstrated dramatically that even the normal person under stress could develop a re- versible emotional illness and psychiatric care could lead to a speedier and more humane restoration of function. The concept of psychosomatic medicine popularized in the thirties received greater recognition and in medical education, attention was focused upon the role of emo- tions in the genesis of physical symptoms. It became more acceptable for a patient to consult a psychiatrist. The sixties will see more progress into the realm of preventative medicine by the understanding of those social patterns which lead to the dissemination of emo- DR. E. W. Bossa Chairman of the Department social and community psychiatry. An additional drive will be made at all levels of medicine to make available the skills of the psychiatrist in the therapeutic armamen- tarium of the non-psychiatric physician. Although this is the age of the gene, the biochemical equation, and the neurophysiological dysrhythmia, the psychological reaction to disturbed organic patterns cou- pled With a sound medical orientation still remains as the treatment cornerstone for the reversal of inappro- priate behavior and the maturing growth of individual personality. The physical therapies, such as psychotropic drugs, permit the disturbed patient to receive appropriate treat- ment designed to relieve his condition while remaining fContinued on page 1332 tional illness and the growth of what is now known as ::.,- Q. l a I gy I ff f gi DR. LLEVVELLYN DR. BRESSLER DR. LOVVENBACH nineteen

Page 22 text:

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

Page 24 text:

MEDICIN The Department of Medicine traditionally has the responsibility of preparing the student for a lifetime of learning as he gives care to patients who ask him for help. The first step is to begin to think and act like a doctor. Two courses in the second year, Introduction to Clinical Practice and Clinical Microscopy, prepare the student so that he can take an active role in patient care. In the third and fourth years. the student assigned to Medicine acts in the role of a physician. His desire to give good care is the motive which drives him to ex- cellence. He learns to properly identify the problems of the patient. Having identified the problems, he mar- shalls the information which he can bring to bear on them by his past training, he recognizes the gaps in his knowledge as he attempts to focus the information learned from the basic sciences onto the specific clinical prob- lem. Using the patient as his means of integration, he re-reads his anatomy, physiology, microbiology, phar- macology and biochemistry. ln this clinical setting he has the opportunity to speak many words which he has previously only read, be discusses the problem with his fellow students, interns, resident and senior staffg he gains familiarity with ideas and concepts by actively manipulating them. The student crystallizes out his idea of the best diag- nostic and therapeutic approach to this particular pa- tient. He identifies the reasons for each of these de- cisions. He has real curiosity to see if his evaluation of the situation is correct or if he will have to admit that certain data which he interpreted as rock-like support for his house of cards have turned out to be shifting sand. He learns that the course of biology is unin- 251 Huenced by strong statements, by the rank of the faculty fl l . Q Ls t--' iiii fi 4? 4 A i ,f at 1 if ,., f ' ...,.,, it w Zts ':': ' 1 i: 1-- :- ',,,er: t' DR. STEAD member, or by the number of supporting references not quite applicable to the points in question. Under guidance from his fellow students and from faculty of all ranks, he slowly appreciates the difficulties of learning in this system of multiple variables operating on only partially defined substrates. Part of a doctor's learning is only experiential. He knows from living with his patients that certain things are possible, but he does not know the underlying sequence of events. In other instances, his learning is more precise because he understands and can control some of the important variables. He must learn both the liabilities and virtues of attempting to use logic in clinical practice. The goal of the Department of Medicine is for the student to have as many learning experiences as possible in which he plays an active role. We hope that he will -N., .-,.. N. ,. ,,., .. . X X,-5-cfs-P' DR. ORGAIN DR. HANSEN-IDRTTSS DR. RUFFIN twenty