734 



SCIENCE 



[N. S. Vol. XXXVII. No. 959 



It has been interesting to observe the 

 attempts which have recently been made 

 more fully and rapidly to utilize the new 

 knowledge in the underlying sciences for 

 the furthering of the work of diagnosis 

 and therapy in the clinics. On the one 

 hand, the older clinicians have heroically 

 endeavored to acquaint themselves with 

 the new facts as they have appeared; and 

 they have hastened to surround themselves 

 in their wards and in the clinical labora- 

 tories with younger men, trained in the 

 newer laboratory methods, men who could 

 aid them in the work of clinically applying 

 the new facts. And, on the other hand, 

 several universities have recently appointed 

 to important clinical positions men who 

 have been trained predominantly in the 

 laboratory branches and who have made 

 their early reputation in pathology, physi- 

 ology, anatomy or chemistry, rather than 

 in the clinical sciences. In these instances, 

 we see two methods used to overcome a 

 great difficulty and both are laudable. 

 Each of them has led to advances in clin- 

 ical teaching and research, but each of 

 them is subject to obvious disadvantages. 

 In the one instance, the clinical problems 

 may be in the foreground, but insuificient 

 personal acquaintance with the newer fun- 

 damental facts to be utilized limits vision ; 

 moreover, the lack of machinery for the 

 utilization of the newer knowledge ham- 

 pers the organization of diagnostic and 

 therapeutic investigation. In the other in- 

 stance, there is a real danger of an under- 

 appreciation of the nature, significance and 

 scientific importance of the problems of 

 diagnosis and therapeusis as such; the 

 clinical appointee especially when un- 

 trained, or only slightly trained, in clin- 

 ical work, and previously nursed in a 

 fosterage, perhaps unfamiliar with, or even 

 mildly disparaging of, the work of the 

 clinic and of clinicians, may feel actually 



ashamed to work at the bedside and in the 

 laboratory at truly clinical problems, feel- 

 ing that his former colleagues, to whom he 

 may owe his appointment, will regard him 

 as a scientific clinician only when he avoids 

 researches bearing directly upon diagnosis 

 and therapy and devotes his energies to 

 the solution of non-clinical problems, the 

 attack on which properly belongs to the 

 laboratories of pathology, physiology or 

 chemistry. 



The situation is gradually righting itself. 

 The non-clinical scientists realize better 

 than they did what clinical work is and 

 should be, and that workers in clinical 

 branches should not be expected to leave 

 their own fields to conduct other researches 

 any more than the clinician can expect the 

 anatomists or the physiological chemists to 

 solve either the diagnostic and therapeutic 

 problems of the clinic or the fundamental 

 problems of physics and mathematics. All 

 are acknowledging that the problems of 

 diagnosis and therapy are tasks set by the 

 patients themselves, that these living pa- 

 tients are, primarily, the objects of study 

 of the clinical scientist. For this study a 

 fine imaginative vision — properly schooled 

 and rigidly controlled — is desirable. Pa- 

 tients must, in each generation, be looked 

 at with fresh eyes, intellectualized partly 

 by accurate training in the most recent 

 clinical technique, partly by previous edu- 

 cation in the methods, facts and hypotheses 

 of the non-clinical sciences. It is gratify- 

 ing that clinical men themselves, including 

 those with extended training in one or 

 more of the non-clinical sciences, are, more 

 than ever before, recognizing the worth 

 and dignity of diagnosis and therapy 

 as sciences per se — that is to say, as 

 bodies of knowledge to be increased, not 

 merely as arts to be practised — sciences 

 to be cultivated for their own sake as 

 intensively, as proudly, and as enthusi- 



