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On occasion of a Historic Medico-Surgical Exhibition. The A. analyses the evolution of medical discourse: in the early phases considering the patient as an object of charity (humanistic concept); later as a biological subject (scientific concept) and, finally, in our days, as an object of analysis (technological concept forgetting the human being and his personality). The big scientific-technological advance in individual medicine contrasts, nevertheless, with its incapacity to solve the major social problems of our time (AIDS, drugs) and to maintain a reliable organization in regional wars (Yugoslavia, Africa). Keeping this background in mind, the A. comments on the evolution of Portuguese medicine and some of it traits.

Leriche's La Maladie post-opératoire was described in 1934 as a specific and general reaction to surgery whose systemic symptoms could'nt be understood by the clinical appraisal alone. A laboratory analysis would be necessary. According to Leriche the syndrome could be observed also on other non-surgical trauma. Leriche's concept was ignored by the anglo-saxonic literature but a new scientific approach to the same problem came from Harvard. Walter Cannon with his concept of homeostasis and Henderson, Gamble, Peters and Van Slyke with their definition of the chemical anatomy of the organic fluids and their quantitative analysis, opened the way to Francis Moore's concept of surgery and trauma as metabolic problems. This new biological basis, and the broad enlargement of its spectrum to the whole body, gave a new scope to the surgical practice. Surgery must now be considered as an integrated process, a succession of phenomena defined as pre-operative, per-operative and post-operative representing, nevertheless, a true continuity. To its understanding the post-operative phase cannot be separated from the other phases. La maladie post-opératoire cannot be defined as an unity: there are several post-operative diseases. But the surgical patient must be considered always in the totality of his elements: the somatic or anatomical, the metabolic or physiological and the psychic, forming a complete unity. A global vision versus the old local vision of surgery. This enlarged concept of surgery enables the surgeon to have an intellectual approach similar to that of the physiologist.

Clinical teaching at Lisbon's Faculty of Medicine is analyzed in its two phases: 1. A period of stability and continuity of the institution (from 1911 to 1947) characterized by good rules in the selection of teachers: an impressive group of personalities (F. Gentil, Pulido Valente, Reynaldo dos Santos, Egas Moniz, A. Flores, Sobral Cid, Lopo de Carvalho, Gama Pinto, etc). At the same period a true University Hospital (of Santa Marta) provided clinical investigation (cerebral angiography and leucotomy, aortography and arteriography of the limbs, angiopneumography, endarterectomy) and the creation of new specialities (neurosurgery, vascular surgery, pneumology) (Act. Méd. Port. 1990; 2: 109-114). 2. A period of instability due to a deleterious political intervention (from 1947 to the present day) responsible for the destruction of the structure and concept of a new teaching hospital (Hospital de Santa Maria). As a result of the socio-political situation conflicting laws and vicious rules lead to an excess of non-selected teachers and an alarming increase of students, patients and medical doctors A change from the present situation and a new concept of clinical teaching must be imagined.

Clinical teaching at Lisbon's Faculty of Medicine is analyzed in its two phases: 1. A period of stability and continuity of the institution (from 1911 to 1947) characterized by good rules in the selection of teachers: an impressive group of personalities (F. Gentil, Pulido Valente, Reynaldo dos Santos, Egas Moniz, A. Flores, Sobral Cid, Lopo de Carvalho, Gama Pinto, etc). At the some period a true University Hospital (of Santa Marta) provided clinical investigation (cerebral angiography and leucotomy, aortography and arteriography of the limbs, angiopneumography, endarterectomy) and the creation of new specialties (neurosurgery, vascular surgery, pneumology). 2. A period of instability due to a deleterious political intervention (from 1947 to the present day) responsible for the destruction of the structure and concept of a new teaching hospital (Hospital de Santa Maria). As a result of the socio-political situation conflicting law and vicious rules lead to an excess of non-selected teachers and an alarming increase of students, patients and medical doctors. A change from the present situation and a new concept of clinical teaching must be imagined.