SUNY Downstate Medical Center - Iatros Yearbook (Brooklyn, NY)

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so 4 v O Y 'ghriq A 4, ay f, 3. s v SW? 2 E , , l it? - uw If-vw Vo 4 P, f ' :A - Y af!-sv morphology. In the one case as in the other the deficiency may be offset in some measure by a sort of filling in process' but concurrent maintenance of the required collateral study would subtract energy, and detract interest from the all-important work in hand, and be, therefore, uneconomical as well as inefficient. By the present, generally adopted serial sequence of subjects making up medical school curricula this difficulty is avoided, provided the pre-clinical courses of instruction are adequate for clinical purposes. The fact that teachers of the clinical subjects habitu- ally re-state relevant physiologic facts and principles in their explanations of particular disease types is in no sense anomalous, nor is it indicative of inadequacy of the X-vw! fi' my o , I I ' instruction in the preliminary subject: for teachers of physiology quite as habitually discuss physical, chemical, physico-chemical and morphologic data and generaliza- ' tions, though their pupils are reputed to have received really adequate instruction in ' each and all these branches. Justification for this practice is afforded by the fact that in many, if not in all such instances satisfactory explanation actually involves such citation. Nor should this practice be looked upon as objectionable or uneco- : nomical. On the contrary, it seems distinctly advantageous and therefore advisable , because it serves, not only to accentuate the interdependence of these related branches of science but, by repetition and contemplation of the same ideas from more than one viewpoint, to deepen, broaden and more firmly hx the minimal moiety of organ- : ized knowledge with which a prospective practitioner of medicine should be equipped. In order to apply, intelligently, a given scientific concept or generalization one must clearly apprehend its real significance: and such apprehension is most surely and economically attained by intensive study of the phenomena upon which it is based. ln the case, for example, of a given physical concept applicable to a physiologic problem, the student who has previously concentrated his attention wholly upon the data and reasoning from which the physical concept was derived long enough to clearly visualize its full meaning will, later, find no difficulty in applying it: where- as, one who has hurried over consideration of the basal concept in order the sooner to apply it, will be liable to wander seriously astray in his attempted applications, because he does not understand that which he is trying to use. Whoever follows such a course may appear to advance, but his successive inferences will be less and less secure and his conceptions more and more hazy, because of his failure to firmly establish primary conceptions before venturing beyond them: and if he continues to proceed in the same way his course will carry him into pseudo-science, to which no ' knowledge at all is preferable, because it seems to be what it is not. Therefore, a teacher of physics should teach physics: inciting in his pupils, if he can, an interest , in its problems comparable in kind, even if not in intensity with his own, and exert- ing his every effort to aid them in the acquisition of a thoroughly well-grounded knowledge of that subject per seg knowing full-well that its future applicability will 5 be commensurate with its lasting soundness. I I ' A similar principle should guide the teacher of animal physiology. If teaching A in a medical school he may, and naturally does point out some of the obvious and evident consequences of variation from the normal standard of cardiac, vascular, respiratory and metabolic activities: and he, quite properly, discusses the effects of 1 3 -4-1 ' I certain definite lesions of the human cerebro-spinal and autonomic nerve systems in L l v -- 'ur af- -f. H f I .f.- 1.114 11125 V at 1? 'a l vt ' 'H v Y KU! - f v 'iii - KMA Page Eighmcll

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90? , - g ig:-3-fy, j--ar --s :QQ o cn-, .fra-M -- Eaves - .ss-if 1 'ft' 1 ' i f ff1':'1f'9g-:q.4w:i.1s.,,.,f -.qs-. ,.g,' aa- ,wp-,,,,m ,, ,-.,,:,. a,.,..,..d,,,:,-,,, le 4 with .11 'lrf' Q-1'-4-if-K'A.-:is in ,.-.-:: p 1:l.., -as-we .1-1,1 ..'.. I sc-. 'f:.. 1 s-G5-551:31-fS?1f5sf:-ES' -.-v fs'-rr -:.. 1-sh-..-J ,,., -.ff-131' -v.- 3 '-i-iii , . ly: V Q fir I Ka.. .1.f--.-, ,... s 1.A .i ,2,V:....... ,. M ,,,., , ..,., .,fEe??tr-a':,,.,.,, .,,.- :,f- ' 1 . Teachers of physiology in our medical schools should never lose sight of the interrelations between the' subject in which they give instruction and the other sub- divisions of the curriculum. The gross fact that some degree of acquaintance with animal, and especially with mammalian physiology is pre-requisite for the study of clinical medicine and surgery is so generally obvious as to scarcely require pointing out: as is also the fact that detailed knowledge of particular physiologic processes and reactions is essential for the solution of more than a few clinical problems. ' Broadly speaking, states of disease are clearly intelligible only when viewed as deviations from, or variants of normal states: and, therefore. not only does animal ' physiology furnish a sound basis for clinical interpretation, but careful study of certain clinical variants throws additional light on the physiologic processes concerned in their genesis. For example:-lnterpretation of any one of the several types of diabetes requires familiarity with the details of carbohydrate metabolism, while detailed study of these very types has greatly aided physiologists in the unravelling of the skein of processes involved in the metabolic history of carbohydrates. Chiefly because of this close interrelationship, and consequent mutual helpfulness, animal , physiology has been, since its inception as science, continuously and pre-eminently nurtured by the medical profession: from the ranks of which many of its ablest workers have emanated, while the most completely equipped of its laboratories have developed in connection with, and are still part and parcel of medical schools. It is not, therefore, surprising that animal physiology has been for long, and continues to be ranked as a basal branch of medicine. But, while admitting this fundamental I relationship, working physiologists claims for the subject a far wider range of interest and usefulness: viewing it as a distinct sub-department of physical science, the problems of which are intrinsically interesting. Naturally, therefore, teaching physiologistl , endeavor to incite such interest on the part of their pupils: which, though it may ' actively endure no longer than the period of undergraduate instruction in the subject, is the most valuable of incentive to the acquisition of real and lasting knowledge. fl A A student who plunges into clinical medicine inadequately equipped with Q ' .3 ready and reliable knowledge of either physiology, pathology or bacteriology is as gp - seriously handicapped as one who undertakes detailed study of physiology unequippecl bfgqxg with sufficiently sound and extensive knowledge of either physics, chemistry. or :JA l H l u a ci- ses .. . sw we Page Srvenieen

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' mo.- ., if ry v i e. R--R--as --R----E Wy, f' if S5 X i v - rf fl? 4635 Y, 1 5 . .- - . comparison with similar experimental lesions in other mammals. He may even venture a step farther: teaching the student how to detect by physiologic methods certain reactionary deviations from normal, and how to explain on a physiologic basis certain typical syndromes: thus easing the grade of the student's advancement from laboratory to bedside by indicating how his acquired knowledge may be clini- ,7 N1 I f cally applied. This is done in the, now developing, course in clinical physiology: , durmg which the student is instructed in methods of use of the stethoscope, sphygmo- 3 graph, polygraph, sphygmomanometer, cardiograph, electrocardiograph, stethometer, spirometer, opthalmoscope, laryngoscope, instruments for determining the partial pres- sure of carbon dioxide in blood and alveolar air, and in methods of study of human 1 digestion and basal metabolism. . But the extent to which a mere laboratory worker may safely, or advisedly . venture into the field of the clinician is obviously quite limited. If he turns over to ' ! the clinical teachers, students well grounded in knowledge of those portions of animal ' physiology that admit of clinical application together with definite notions as to how such knowledge may be applied, he will have done his duty: for, specific application . of the physiological to the clinical is as distinctly the duty of the teaching clinician i as specilic application of the physical to the physiological is the duty of the teaching physiologist. And if, as occasionally happens, the besal science fails to furnish a formula for the special combination of circumstances presented by a case or problem ' under consideration, it is the duty of the teacher who makes the application to clear the way: which he will find no difiiculty in doing if the student has been well drilled in the elements of the basal science. For example :-Of the many excellent treatises on hydraulics written by physicists not one offers a satisfactory explanation of the How of a liquid under the precise combination of circumstances presented by the vascular system of a mammal. Yet anyone who has mastered the principles of hydraulics as laid down in those treatises will readily discern their applicability to problems of blood-circulation: and unless, or until one understands the purely mechanical principles involved, the genesis and variations of blood-pressure, blood-velocity and pulse will not be fully comprehended. Numerous other such examples could be given: but this one, alone, seems to elucidate sufficiently the contention that the teacher of physiology should teach physiology, clearly, precisely and in detail: but should ever remember that he is teaching it as part ground-work for future clinical studies, and therefore broadly indicate its value as such: leaving to the clinical teacher its . actual, specific application. ' I , Joi-iN C. CARDWELL, M.D., Professor CLARENCE E.. KRETZ, M.D., Lecturer GEORGE H. ROBERTS, A.B., M.D.,Lee1urer A if o HARRY Kos'rER. M.D., Instructor li ---, Instructor it tat s as.. Jang P1 zuvzts F W . . .C .. , was WW Page N ineleen