May 16, 1913] 



SCIENCE 



736 



astically as are the more basal sciences. 

 And this is why clinical men are seeing to 

 it that provision is made in the clinics 

 themselves, not for the presence of patients 

 only, but also for elaborate machinery for 

 investigating them; they are demanding 

 and equipping in each clinic a number of 

 laboratories in which physical, chemical, 

 physiological, pharmacological, bacteriolog- 

 ical, psychological and other methods and 

 facts can be directly applied by trained 

 men in the diagnostic and therapeutic in- 

 quiries to which the conditions existing in 

 the patients actually before them lead/ 

 And, in addition to the more permanent 

 staff, they are taking with them to the bed- 

 side and to the adjacent experimental lab- 

 oratories of the clinic groups of medical 

 students, trained in the basal medical sci- 

 ences and making them responsible for the 

 large amounts of routine work of which 

 these students are capable while they are 

 acquiring their early clinical experiences. 

 To obtain proper facilities for clinical 

 study and especially the multiple labora- 

 tories manned by skilled workers necessary 

 in each clinic, not only will miich money 

 be required, but also an awakening of the 

 understanding of the clinical men them- 

 selves, of non-clinical medical scientists 

 and of hospital superintendents and trus- 

 tees to the need. By many it is still 

 thought that the laboratories of the non- 

 clinical sciences can be called upon to do 

 the laboratory work of the clinical sciences. 

 By others, and especially by the superin- 

 tendents of general hospitals (who are 

 forced rigidly to limit the expenditure of 

 money), the fallacy is still cherished that 

 a "general clinical laboratory" in the hos- 

 pital can best do the work of all the clinics 

 for them. This, it seems to me, is a grave 

 error. I am convinced that nothing short 

 I Q.^_ 1 1 rjjjg Organization of the Laboratories in 

 the Medical Clinic, ' ' Johns Eoplcins Hospital Bull., 

 1909, XVIII., 193-198. 



of multiple special laboratory divisions for 

 the direction of which each clinic is itself 

 actually responsible, will ever satisfac- 

 torily supply the needs. Any other ar- 

 rangement will emasculate the individual 

 clinics and paralyze research in diagnosis 

 and therapy. It was for a precisely simi- 

 lar independence for physiology that 

 Purkinje had his great struggle about the 

 beginning of the last century. The uni- 

 versity faculty, and the university Kura- 

 tor put great obstacles in the way. They 

 did not see why physiology should not use 

 the other laboratory (anatomy) for the 

 work. The Kurator sarcastically asked 

 "where will it lead to, if every scientific 

 branch demands its own laboratory?" 

 Thanks to Purkinje 's clear vision and his 

 persistence, and through the influence of 

 Goethe and Alex. v. Humboldt, physiology 

 finally got its independent institute. 

 Von Ziemssen recognized a similar need 

 for the medical clinics and demanded a 

 "clinical institute" for teaching and lab- 

 oratory researches in addition to his hos- 

 pital wards. Only after such salutary 

 conditions as those referred to have been 

 realized in the clinics, and have been main- 

 tained there for a time, can we hope to 

 breed a generation of clinicians in any way 

 approaching the next necessary and realiz- 

 able type — a type resulting from the fusion 

 of training in accurate clinical observation 

 with training in the solution of clinical 

 problems by experimental work in the lab- 

 oratory. The goal stands clearly in the view 

 of those of us who are familiar with the 

 present conditions and are ambitious for 

 the advance of clinical knowledge. That 

 this goal is being rapidly approached 

 should be a consolation to the generation 

 of clinicians chafing under the limitations 

 of the period through which we are pass- 

 ing, more than one member of which has 

 felt keenly the truth of the adage that "the 



