PREFACE Vll 



of disease is sought for largely by the empirical method ; namely, by the 

 endeavor to see and examine innumerable patients, to diagnose the case 

 according to the grouping of the signs and symptoms, and to treat it by 

 the prescribed methods of experience. So much has to be learned and so 

 much has to be seen during the clinical years, that the student gives little 

 thought to the nature of the functional disturbance which is responsible 

 for the symptoms; he fails to realize that after all, there is no essen- 

 tial difference between the condition brought about in his patient by 

 some pathological lesion, and that which may be produced in the labora- 

 tory by experimental procedures, by drugs or by toxins. It must of 

 course be recognized that just as the science of medicine originated by 

 the grouping of symptoms into more or less characteristic diseases for 

 which the most favorable method of treatment had to be discovered by 

 experience, so must a certain part of the medical training be more or 

 less empirical but it should at the same time be realized that such a 

 method is only a means to an end, and that the real understanding of 

 disease can be acquired only when every abnormal condition is inter- 

 preted as a primary or secondary consequence of some perverted bodily 

 function, and when the training in observation and the inductive method 

 is carried from the laboratory into the clinic. 



It is a constant experience of clinical instructors who would employ 

 scientific methods of instruction, that they find the students not only 

 indifferent to an analysis of their cases from the functional standpoint, 

 but also that they are too inadequately prepared in fundamental phys- 

 iological knowledge, to make the analysis possible. The student may 

 have a superficial acquaintance with the main facts of physiological science 

 but have failed to acquire the enquiring habit of mind which will en- 

 able him, through reflection, comparison, and personal research, to ap- 

 ply the knowledge in practical medicine and surgery. 



For this lack of correlation between the laboratory and clinical stud- 

 ies, the clinical instructors are not alone responsible. The laboratory 

 courses are frequently given without any attempt being made to show 

 the student the bearing of the subject in the interpretation of disease, 

 or to train him so that in his later years he may be able to adapt the 

 methods of investigation which he learned in the laboratory, to the study 

 of morbid conditions. It is self-evident that (without any knowledge 

 of disease) the extent to which the student in the earlier years of the 

 course could be expected to appreciate the clinical significance of what 

 he learns in the laboratory is limited, but this should not deter the in- 

 structor from indicating whenever he can, the general application of 

 scientific knowledge in the interpretation of diseased conditions. But 



