THE RELATIONS OF PATHOLOGY 111 



Of fundamental importance for all branches of medicine was the 

 resulting organization of the teaching and investigation of patho- 

 logical anatomy. Following the leadership of Virchow in Berlin 

 pathologico-anatomical institutes or laboratories were rapidly estab- 

 lished, and soon recognized as indispensably necessary for teaching, 

 for research, and for direct assistance to medical practice. In the 

 further course of development these laboratories have undergone 

 various modifications and enlargements of scope, principally as the 

 result of the advent of medical microbiology. 



With surgery and the rapidly developing surgical specialties 

 pathological anatomy - - gross and microscopic soon assumed 

 permanent relations of fundamental character. The anatomical 

 study of the diseases in question was followed by great progress in 

 treatment, and the exponents of these branches of applied medicine 

 did not remain merely receptive of the work of others, but have 

 themselves prosecuted diligently pathological investigations of great 

 value. Indeed, in certain special branches, especially ophthalmo- 

 logy, otology, and dermatology, the clinicians have long been prac- 

 tically the sole occupants of the field of pathological anatomy of 

 their respective parts of the body. The close study of pathological 

 anatomy being largely the study of the results of disease - - stim- 

 ulated also to brilliantly accurate diagnosis of certain internal dis- 

 eases, which unfortunately in some cases was coupled with a dis- 

 heartening therapeutic pessimism. Said the therapeutic nihilist 

 Skoda: "We can diagnose disease, describe it, and get a grasp of at, 

 but we dare not by any means expect to cure it." That some of the 

 followers of cellular pathology in the narrower, dogmatic sense, 

 believed that the innermost secrets of disease could be reached by 

 morphologic methods, and that functional disturbances always could 

 be adequately explained by morphologic means may now be regarded 

 as an instance of the tendency man frequently shows to approach 

 his problems from the least accessible points. These unfavorable ten- 

 dencies in pathology led to the following protest by Clark in 1884: 



'We are so much concerned with anatomical changes; we have 

 given so much time to their evolutions, differentiations, and rela- 

 tions; we are so much dominated by the idea that in dealing with 

 them we are dealing with disease itself that we have overlooked the 

 fundamental truth that these anatomical changes are but secondary 

 and sometimes the least important expressions or manifestations 

 of states which underlie them. It is to these dynamic states that our 

 thoughts and energies should be turned; they precede, underlie, 

 and originate structural changes; they determine their character, 

 course, and issues; in them is the secret of disease, and if our control 

 of it is ever to become greater and better, it is upon them that our 

 experiments must be made." 



