736 



SCIENCE 



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



man who rings the bell can not march in 

 the procession." 



The state of affairs to which I have re- 

 ferred has, to a certain extent, been re- 

 flected in the membership, and in the pro- 

 grams of the meetings, of this association. 

 In 1886, the membership was made up 

 chiefly of clinicians with a sprinkling of 

 laboratory workers. In 1899, of 118 mem- 

 bers, some 18 were pure laboratory work- 

 ers who saw no patients at all. At present 

 of 131 members, some 32 are pure labora- 

 tory workers who do not see patients, and 

 many more are largely engaged in experi- 

 mental work. Of the associate members, 

 from whom our new members are in the 

 near future to be drawn, at least one third 

 are men who do not study patients but are 

 engaged entirely in laboratory teaching or 

 research. 



A glance over the program of the meet- 

 ing of 1899 shows that three non-clinical 

 and twenty-seven clinical papers were pre- 

 sented. Last year, the program listed some 

 thirteen non-clinical and some forty-six 

 clinical papers. Our program this year in- 

 cludes some fourteen non-clinical and some 

 fifty-one clinical papers.^ A large propor- 

 tion of the papers classed as clinical are re- 

 ports of combined bedside and laboratory 

 work. Now, on the whole this must be re- 

 garded as a very gratifying showing, illus- 

 trating, as it does, the great expansion in 

 our clinics of work by experimental meth- 

 ods, as contrasted with work by more 

 purely observational and statistical methods. 



None welcomes, nor confides in, the 

 experimental method more, perhaps, than 

 I, but the observational method also de- 

 serves ever new application in clinical 

 work. Is it not conceivable that we may 

 actually retard progress in diagnosis and 



' In making this arbitrary division into clinical 

 and non-clinical papers I am guided by the direct 

 relationship of the topic to the diagnosis and 

 treatment of disease in human beings. 



therapy if we center investigation in our 

 clinics and in their laboratories upon prob- 

 lems far removed from the conditions ob- 

 servable in the sick? May it not be de- 

 sirable to plan that the experimental work 

 in the clinics shall, for the most part, bear 

 directly upon the problems of diagnosis 

 and therapy (of course, in a wide sense, 

 including etiology, pathogenesis and prog- 

 nosis), and to arrange that the more funda- 

 mental physiological and experimental 

 pathological inquiries be relegated to those 

 laboratories, the particular business of 

 which is to advance the sciences of general 

 physiology and general pathology. Unless 

 clinical men jealously guard their time, 

 their interest, their energies and their 

 materials in order to devote them to the 

 advance of the clinical sciences, the prog- 

 ress of diagnosis and therapy must be 

 slowed. Not that a clinician may not 

 become so interested in pathology, physi- 

 ology or physics as to make it justi- 

 fiable for him to leave the clinic and 

 occupy a non-clinical post. The clinics can 

 only be proud to send occasionally a 

 Helmholtz to physiology, as chemistry may 

 be glad to contribute an Ostwald to phi- 

 losophy. A man must go where his cere- 

 bral cortex leads him, be it from physic to 

 physics, as in Helmholtz 's case, or from 

 crystallography to therapy, as in Pasteur's. 

 Moreover, even in truly clinical investiga- 

 tion there will often be non-clinical by- 

 products of great scientific value to which 

 there can be no objection provided the 

 main product corresponds to the aims of 

 the clinical sciences. But, at this time, it 

 would seem important to emphasize that 

 researches in general physiology and in 

 general pathology, valuable and desirable 

 as they are for the progress of the medical 

 sciences, as a whole, pertain to a field other 

 than that which the clinics themselves 

 should predominantly cultivate. May I il- 

 lustrate by an analogy ? Were our physiol- 



