go 



NA TURE 



May 28. i8q6 



fundamental properties of living matter. We already know 

 that living matter is not that homogeneous, formless substance 

 which, not many years ago, it was believed to be, but that it 

 possesses a complex organisation. 



rr.icticil medicine has been profoundly influenced by the 

 unparalleled development of the medical sciences during the 

 last fifty years, and especially during more recent years. Scien- 

 tific methods have passed from the laboratory to the hospital. 

 Cases of disease are now studied with the aid of physical and 

 chemical and microscopical and bacteriological methods. The 

 diagnosis of disease has tliereby been greatly advanced in 

 jirecision, and if Boerhaave's motto, qui hate diagnoscit , bene 

 iiiedeliitiir, be true, there should be a corresponding advance in 

 the results of the treatment of disease. Whether or not this 

 dictum of the old master be true — and I have serious doubts as 

 to its entire truth — it cannot lie doubted that great progress has 

 been made in medical, and especially in surgical treatment as a 

 result of scientific discoveries, although the treatment of disease 

 still rests, and will doubtless long continue to rest, largely upon 

 empirical foundations. 



We are assembled here to-day to assist at the opening of a 

 laboratory which gives the fittest and strongest possible expres- 

 sion to the influence of scientific work upon practical medicine. 

 The generous founder has marked with characteristic insight the 

 direction in which the current is setting. 



The conception of a thoroughly equipped laboratory as an 

 integral part of a hospital and intended for the study and 

 investigation of disease is of recent origin. The germs of this 

 idea, however, may be traced back to such men as Hughes 

 Bennett and Beale in Great Britain, and to Krerichs and Traube 

 in Clermany, who in their hospital work made fruitful application 

 of microscopical, chemical, and expermiental methods. A little 

 over ten years ago, von Ziemssen, in Munich, established a 

 well-conceived clinical laboratory, containing a chemical, a 

 physical, and a bacteriological department, a working library, 

 and rooms for practical courses and the examination of patients. 

 A similar laboratory was secured by Curschmann in Leipzig in 

 1892. 



The growing recognition of the need of such laboratories is 

 the result of the great progress in scientific medicine during 

 recent years. The thorough clinical examination of many cases 

 of disease now requires familiarity with numerous technical 

 procedures, physical, chemical, microscopical, and bacterio- 

 logical. The laboratory outfit required simply for routine 

 clinical examinations is considerable. A microscope and a few 

 lest tubes and chemical reagents for simple tests of the urine no 

 longer suffice. As illustrations of this, I call attention to the 

 clinical value of examinations of the blood, of the contents of 

 the stomach, of fluids withdrawn from the serous cavities, of the 

 sputum and various secretions, of fragments of tissue removed 

 for diagnosis. Such examinations require much time, trained 

 observers, and considerable apparatus. To secure for the 

 patients the benefits in the way of diagnosis, prognosis, and 

 treatment to be derived from these methods of examination, a 

 hospital should be supplied with the requisite facilities. 



A hospital, and especially one connected with a medical 

 school, should serve not only for the treatment of patients, 

 but also for the promotion of knowledge. Where this second 

 function is prominent, there also is the first most efficiently 

 and intelligently carried out. Herein we see the far-reaching 

 beneficence of a laboratory, such as this one, thoroughly 

 equi|jped to investigate the many problems which relate to 

 clinical medicine. 



The usefulness of an investigating laboratory in close con- 

 nection with a hospital has already been abundantly demon- 

 strated. Chemical studies, more particularly those relating to 

 metabolism in various acute and chronic afiections, micro- 

 scopical and chemical investigations of the blood and bacterio- 

 logical examinations of material derived directly from the 

 jiatient, may be mentioned as directions in which researches 

 conducted in hospital laboratories have yielded important results 

 and will garner still richer harvests in the future. 



There need be no conflict between the work of clinical 

 laboratories and that of the various other medical laboratories. 

 Kacli has its own special field, but it is not necessary or desirable 

 to liiaw around these fields sharp boundary lines beyond which 

 there shall be no poaching. It will be a relief to pathological 

 anil other laboratories to have certain examinations and subjects 

 relating directly to practical medicine consigned to the clinical 

 laboratory, where they can receive fuller and more satisfactory 



NO. 1387, VOL. 54] 



consideration. The subject-matter for study in the clinical 

 laboratory is primarily the patient and material derived from the 

 patient. Anatomical, physiological, pathological, pharmaco- 

 logical, and hygienic laboratories must concern themselves with 

 many problems which have apparently no immediate and direct 

 bearing upon practical medicine. In the long run their con- 

 tributions are likely to prove most beneficial to medicine if 

 broad biological points of view, rather than immediate practical 

 utility, are their guiding stars. The clinical laboratory will con- 

 cern itself more particularly with questions which bear directly 

 upon the diagnosis and the treatment of disease. 



To the small number of existing well-equipped clinical 

 laboratories the William Pepper Laboratory of Clinical Medicine 

 is a most notable addition. It is the first Laboratory of the kind 

 provided with its own building and amply equipped for research 

 in this country, and it is not surpassed in these respects by any 

 in foreign countries. It is intended especially for investigation 

 and the training of advanced students. It is a most worthy 

 memorial of the father of its founder. 



William Pepper the elder was a very distinguished physician 

 and trusted consultant of Philadelphia, for many years an attending 

 physician at the Pennsylvania Hospital, where he was a clinical 

 teacher of great influence, and for four years the professor of 

 the theory and practice of medicine in this University. He 

 belonged to that remarkable group of American physicians, 

 trained under Louis, who brought to this country the best 

 methods and traditions of the French school of medicine at 

 the time of its highest glory. His diagnostic powers are said 

 to have been remarkable. With his broad sympathies, his lofty 

 ideals, and his active and enlightened efforts for the promotion 

 of clinical medicine, how he would have welcomed such 

 opportunities as will be afforded by this laboratory to contribute 

 to a better knowledge of the nature, the diagnosis, and the 

 treatment of disease ! 



Our country has until within a very few years been deprived 

 of the encouragement and opportunities for original investiga- 

 tions in the medical sciences afforded by large and thoroughly 

 equipped laboratories. We can still count upon the fingers of one 

 hand our medical laboratories which are comparable in their con- 

 struction, organisation and appliances to the great European 

 laboratories. Notwithstanding these obstacles, there have been 

 .■\merican physicians of whose contributions to medical science 

 we may feel proud. 



But a new era has dawned. Of that we are witnesses here 

 to-day. The value of medical laboratories is now widely 

 recognised among us. To those of us who appreciate the 

 underlying currents in medicine, who follow with eager 

 interest the results of the almost feverish activities in foreign 

 laboratories, who recognise the profound interest and import- 

 ance of the many medical problems which await only patient 

 investigation and suitable facilities for their solution, and who 

 would like to see our country take the prominent position it 

 should in these investigations, our laboratories may seem slow 

 in coming, but they will in time be provided by enlightened 

 benevolence. The individual or institution or hospital which 

 contributes to the establishment of a good laboratory devoted to 

 any of the medical sciences merits in unusual degree the 

 gratitude of all medical men ; yes, of every true friend of 

 humanity. Such gratitude we feel for the generous and public- 

 spirited founder of this laborator)', who has contributed largely 

 to the advancement of medicine in this country, and of whose 

 splendid services to this university I need not speak in this 

 presence. 



I congratulate this city and this university and this hospital 

 upon the important addition made by this laboratory to higher 

 medical education and the opportunities for scientific work in 

 this country. May the enlightened aims of the founder, and 

 the hopes of all interested in the promotion of medicine in 

 this country, be fulfilled by the scientific activities which 

 will now begin in ihe William Pepper Laboratory of Clinical 

 Medicine. 



UNIVERSITY AND EDUCATIONAL 

 INTELLIGENCE. 

 Oxi'ORi). — At the EnCKuia this year (June 24) it will be pro- 

 posed to confer the honorary degree of D.C.L. upon Sir 

 Archibald Cleikie, among others. 



The Rolleston memorial prize has been awarded to Mr. Horace 

 M. Vernon, for his dissertations on (i) the effect of environment 



