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APPENDIX V.

REPORT OF THE DIRECTOR OF THE MEDICAL COLLEGE.

To the President of the University:

Sır:- I have the honor to present the following report upon the Medical College for the year 1908-1909.

Beginning with the session of 1908-1909, the requirements were raised so that a degree from certain accredited colleges became necessary for admission. The immediate result was the registration of but three students in the first-year class, as against 70 the previous year. . At Ithaca 13 students were admitted as against 33 the year before. The admission to the other classes remained about the same, as the change in requirements applied only to the first. The effects of this unprecedented decline might have been disconcerting had it not made it easier to inaugurate the changes involved in widening the instruction to be offered the better prepared students we now seek.

Our curriculum so far, has been arranged to produce graduates fitted to enter at once upon the practice of medicine. Now it must be arranged, not only for the production of such graduates but of those who propose to become teachers as well, and also of those who desire to become investigators, with the intention perhaps of entering public service as medical sanitary officers in connection with the civil, military, or naval departments of the government.

The rapidly increasing demands of “Preventive Medicine,” resting as it must upon the broadest principles of sanitation, made necessary a more comprehensive curriculum, particularly in the first and second years. To this end, Chemistry, Bacteriology, and Physiology had more space assigned them and steps were taken to extend the field of Clinical Pathology.

Hygiene bearing such an important part in "Preventive Medicine,” it is interesting to know that we are well equipped to pursue the study of it without undue elaboration in the direction of separate courses. At Ithaca and in New York the entire ground is so well covered, it only needs slight additions to work already being pursued in the University, together with some cooperation and coordination, to enable this division of the school, conjointly with

Ithaca, to present the subject succinctly and clearly in its entirety. No addition to the present staff is needed to accomplish this end.

Heretofore Anatomy has been presented by us with an eye almost exclusively to its clinical uses. This was in keeping with the avowed purposes of the school, and Professor Woolsey and Professor Haynes developed a system of instruction to that end, the equal of if not the superior to any I know of. Now, while in no way hampering its presentation in that fashion, the Department has been broadened so as to embrace Embryology,Comparative Morphology,and Histology. These subjects have heretofore been taught in connection with the Department of Pathology. The transfer to the Department to which they rightfully belong insures for them a fuller development, a development in keeping with the demands of any one who may desire to pursue anatomy from the standpoint of research, with or without intention to acquire it for clinical purposes. The entire course in Anatomy is arranged so that no matter how much time may be given to it as a purely scientific study, the graduate must finally pass out at the practical gate. To this end, Applied Anatomy medical and surgical, is a final and obligatory study in this course.

Neurohistology which heretofore has been given by Doctor Schlapp in conjunction with his course on Neuropathology is now brought with General Histology into this Department. It will be developed under the immediate charge of Doctor Strauss, so as to afford every opportunity for such students as are specializing in Neurology and Psychopathology, to carry on research and investigation as thoroughly as they may desire.

The school has been fortunate in securing for the chair of Physiology Professor Graham Lusk. It is superfluous to say that this subject will be presented upon such a plane of completeness and efficiency as to meet all the requirements of scientific and practical medicine. For those who desire opportunity to pursue pure physiology without relation to its bearing on practical medicine, no opportunity will be wanting, but the bearing of physiology on the problems of clinical medicine and surgery will be kept fully at the front with students studying for the degree of M.D.

An interesting question closely touching medical education is the relation the study of chemistry should have to it. Clearly inorganic chemistry should be a prerequisite, as it now is with us, but organic chemistry stands so squarely across the path leading to physiological and pathological chemistry, it not only cannot be ignored but must have a place of no small dimension. It must be presented at any rate with us so fully and clearly as to permit the student readily to grasp the intricacies of the more obscure and difficult facts of the chemistry of the human body. And for such as desire to pursue a course in experimental physiology, experimental pathology, or therapeutics it is indispensable. As the science of medicine advances it is fair to assume that its importance to medical education will be steadily enhanced.

The Department of Pharmacology has been broadened by the appointment of Professor Coleman as Professor of Clinical Medicine and Applied Pharmacology. This means that Professor Coleman will teach the clinical application of all pharmacological substances, so that within the limits of the Department each remedy will be studied in its entirety, first in the laboratory under Professor Hatcher, then at the bedside under Professor Coleman, the clinical demonstrations to be preceded by a series of lectures by Professor Coleman, explanatory of the therapeutic properties and uses of all remedies covered by the Department. He will deal in a similar manner with all other therapeutic agents which may lie outside the domain of pharmacology,excepting such as may be classed under the head of surgical procedures. In this way it is hoped that every remedy, no matter of what nature or substance, which is proven and accepted as a means of combating disease, will receive adequate attention at our hands. No one is better fitted to fill this field than Professor Coleman and we consider ourselves fortunate in that he undertakes the task. Professor Hatcher, as Head of the Department, gives his cordial approval to the cooperation of Professor Coleman in thus rounding out and completing the purposes of Pharmacology and Pharmaco-dynamics.

This is an appropriate place at which to consider the field which this school has in view for its Department of Therapeutics. Reference to textbooks will show that the term "Therapeutics" is used in treatises on Materia Medica to cover the consideration of the clinical uses of the particular substance described. This aspect of therapeutics is assigned to Professor Coleman.

In treatises on the "Practice of Medicine," the section which covers the consideration of any one disease, pneumonia, for instance, is headed “Treatment,” or in some books “Therapeutics." It tells how the particular ailment should be treated, and necessarily names a number of remedies, drugs, or other than drugs, to be used early or late according to the shiftings of the scene. The treatment of the several diseases and their phases, each in regular order, is thus unfolded to the student. His crowning conception is, therefore, of such or such an ailment with its remedies and measures of relief grouped about it. Remedies whose properties and varied applications he has already learned in the Department of Pharmacology are now gathered for a definite purpose about a particular problem. This problem being but one of many he is to face, and the whole object of all his studies in medicine being to learn their solution, it is most proper that as a finality, problems and solvents should be comprehensively and clearly impressed on his mind. It is the purpose of the Department of Therapeutics to do this work. It cannot be done by teaching alone, for each case can present but a fragment of the whole ailment at any one demonstration. A series of didactic presentations are therefore necessary, at which, as has been said, the entire treatment of any one disease, including complications and sequels, is spread as a whole before the student. This method, supplemented with adequate clinical demonstrations, ought to give any student having the preparation given in the years preceding this course (this being in the fourth) adequate knowledge for service in any hospital. It will be noticed that the field occupied by this chair is virtually the practice of medicine, but confined to treatment, the Professor of Medicine being free to develop his subject along the lines of etiology, pathology, diagnosis, prognosis, and clinical medicine. There has been so great an extension of all the subdivisions of the practice of medicine, that the time gained through this arrangement for their development at the hands of the Head of the Department can be fully occupied. Professor Meara assumes charge of the Department of Therapeutics.

The creation of a Department of Experimental Therapeutics was necessitated by the increasing demands of sero-therapeutics. At the same time it is expected to lend itself, as its working staff increases, and as occasion requires, to any problem in conjunction with the Departments of Pathology, Pharmacology, or Therapeutics, which may be sufficiently promising of results. Assistant Professor Beebe assumes the direction of this Department, it being an extension, in fact, enlargement, of the work in which he has already won distinction.

I regret to report the resignation of Professor Adolf Meyer. He goes to Johns Hopkins Medical School where he takes charge of the Department of Psychopathology. Assistant Professor August Hoch takes his place. Professor Hoch has served as an assistant to Professor Meyer and given much evidence of his special fitness for the work to which we have had pleasure in advancing him. Similar expressions apply to Assistant Professor Newcomb of the Department of Laryngology, who since the foundation of the school has served as Chief of Clinic and First Assistant to Doctor Knight. He has been advanced as Assistant Professor to the place made vacant by Doctor Knight's resignation.

I now beg to append extracts from the reports of several of the departments as examples of the kind of work they carry on.

DEPARTMENT OF MEDICINE

The work of the instructors and assistants is efficient and satisfactory.

More experimental work than usual has been carried out.

Various assistants have taken an active part in the clinics of the Head of the Department, also in ward work, being called upon to demonstrate before the class various special lines of research in which they were proficient. Doctor Armstrong has demonstrated examination of gastric cases. Doctor Niles has demonstrated thoracic measurements in tuberculosis. Doctor Barringer has shown methods of cardiometery. Doctor Beebe has frequently given advice regarding the use of sera and organic extracts before the entire class. At the clinic in Bellevue Hospital, Doctor Hartwell has assisted in combined medical and surgical clinics; Doctor Barringer has demonstrated cases of unusual cardiac disease; the X-Ray Department has been frequently made use of; Doctor Hastings has provided microscopic specimens of parasites, etc., derived from the patients who were presented. Doctor Hastings has attended these clinics regularly and has been called upon for opinions regarding cases where the blood examinations, etc., were important. An unusually varied and interesting series of cases were thus presented. Doctor Bailey also gave one or two demonstrations of cardiograms, etc., at these clinics.

In the ward service at the Presbyterian and Bellevue Hospitals pathological material has been presented when possible, after the death of the patient, in confirmation of a diagnosis.

Three new methods have been adopted at Bellevue Hospital which have added to the efficiency of the service and stimulated the interest of the house staff, thereby benefiting all the students.

First. All the surgical staff, including the surgical visiting and assistant visiting members, have made joint rounds at stated regular

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