Long Island College Hospital - Lichonian Yearbook (Brooklyn, NY)

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.- .e M- ,. f i W, K ...J Reymond, Hermann, Burdon-Sanderson, Ptluger and others into the reactions of over- living muscle and nerveg some of which were carried to so extreme a degree of ab- straction that they were pooh-poohed as ultra-scientific and their results labelled as useless Yet the net outcome of these very studies now enable us to explain certain cardiac, vascular and neurologic processes and syndromes which, without this aid, would still be included in the category of the empirical. Similarly, the long series of painstaking researches concerning the role of mineral salts in certain tissue-reactions, so persistently pursued by Sydney Ringer, not only paved a way to richly fruitful. fields of physiologic inquiry but have since, directly or indirectly, led to results some of which, to-day, are of deep clinical significance and broad therapeutic applicability. Such examples, of which there are many, clearly indicate that danger of error is less in the direction of inclusion than in that of exclusion. For, although the most safely applicable of physiologic generalizations are the outcome of work that was clone a decade or more ago, teachers should not forget that their present students are pro- spective practitioners of a decade or more hence. Furthermore, the ffllillilly in scien- tihc method afforded by a well-planned course in animal physiology is, quite apart from the lasting knowledge thereby gained, of no small value as applied to clinical analysis, in support of which abundant evidence is at hand, ready for the gleaming. JOHN C. CARDWELL. l l l Studying the Elffirir PIIFHOTIIEHII of the Heart Beat Page fn 1 nli Iwo

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c. .T-www? l fe:-335-15:1wgwfwc-r-mf:-4-ip-.,-wF:11 , . I V on 4 ,M - - - '.:e.a.rl.J:.. 34.2 '.1:u1: .LL-5:g,i..3! guna l l J knowledge of 'lnlfllll physiology is of value chiefly because it furnishes the nrtural basis upon which Ins mplazzatzrizzs of dlbelbc states rest Patients affected by disease are daily before himg the signs and symp- ' toms they present occurring in more or less distinctly organized groups known as syndromes, These syndromes result from reactions of the previously healthy individual organism to environmental changes Qwhich may be termed patho- logic stimulinj of such magnitude and nature as to detectably injure one or more of the tissues or tissue-systems involved in those reactions or to disturb their harmonious interrelations. From this physiologic viewpoint, disease is, essentially, a disturbance of the dynamic equilibrium of some portion of a living individual, a disturbance of such trend and magnitude as to cause temporary or permanent discomfort to, or actually handicap the individual in the struggle for continuance of existence. To remove, diminish, or bring about compensation for such discomfort or handicap is the aim of the medical practitioner. lVith this end in view he endeavors, by detailed, intensive study of the presented syndrome, to ascertain the locus, nature and cause, or causes of the disturbance of which the syndrome is the outward manifestationg having accomplished which he has diagnosed the case-an essential preliminary to intelligent treatment of it. 4 1 - RONI the viewpoint of the busy practitioner of medicine or surgery, a 14, 2 L if f '. ' ' z - . xg X : . -- X Q2 Because adequate diagnosis of disease involves determination of the location, direction, magnitude and nature of those deviations from the standard, normal state which characterize it, precise knowledge of the normal state is prerequisite for its accomplishment, the degree of accuracy, completeness and, hence, the utility of such diagnosis depending, ultimately, upon the soundness and thoroughness of thc diagnostician's knowledge of the normal course of those processes the disturbed state of which is responsible for the syndrome presented. This conception furnishes a guid- ing principle for the planning and conduction of courses of instruction in physiology in medical schools, in accordance with which instructors should endeavor to instil into the prospective practitioners an actual acquaintance with the subject sufficiently sound, detailed and extensive for ready and reliable application at the bedside. Por' tions of the subject not thus applicable need not be included in such courses or, if included, elaborated to a degree suflicient, only, to make clear whatever indirectly applicable facts or principles may result from their consideration. just what, indeed, to include and what exclude requires, at times, both nicely balanced judgment and cultivated foresight. For the history of medicine furnishes some striking examples of subsequent clinical application of the yieldings of physiologic studies which, during the heyday of their pursuit appeared far too abstract for inclusion in medical curri- -cula. Such, for example, were the elaborate investigations of lVIatteucci, du Bois- Paqc 1'-welity-om'

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