July 28, 1916] 



SCIENCE 



111 



facts, and particularly of facts in their 

 chronological order, was possible until ex- 

 perimental methods were employed. As 

 Neuberger has stated, collection and ob- 

 servation of fact constitute the first step in 

 science, but not science itself. With the ap- 

 plication of the methods that had already 

 been utilized in the sciences of physics and 

 chemistry to biology and medicine, it has 

 often been possible not only to reproduce 

 in animals some particular stage of a dis- 

 ease that has been met with in man, but 

 to study the preceding and succeeding 

 stages in such a process with a completeness 

 that could be afforded in the sick room only 

 through unlimited experience. Any deduc- 

 tions from the haphazard data of spontane- 

 ous disease requires, moreover, unlimited 

 skill in fitting each stage as it irregularly 

 oeeurs, into its proper place. Deductions 

 from a relatively complete and orderly 

 series of experimental facts are at once 

 more rapidly arrived at and more reliable 

 than empiricism. They have the further 

 advantage of suggesting in their genesis 

 other questions that have perhaps never 

 arisen in clinical experience, the answers 

 to which may, however, greatly simplify 

 the problems of medicine. 



When once the fruitfulness of the study 

 of medical problems by methods already 

 employed in the exact sciences became evi- 

 dent to the thoughtful physician, innumer- 

 able questions arose in his mind which he 

 felt sure could now be answered. He felt, 

 let us say, that animal experiments could 

 tell him the exact relation between a 

 shrunken and diseased kidney, a thickening 

 of the arteries and an enlargement of the 

 heart, a combination frequently found asso- 

 ciated, and once the exact relation was 

 known, particularly as to which came first, 

 he felt some method of arresting or pre- 

 venting the process might finally be ob- 

 tained. At first the more ambitious and 



able practitioners endeavored to answer 

 these questions for themselves, working in 

 their laboratories into the still hours of a 

 morning that ushered in another day spent 

 at the bedside and the operating-table. 

 These giants exist even to-day and it is 

 owing to their example, enthusiasm and 

 aid, that some of us are now able to carry 

 on their work with greater single-minded- 

 ness and under less heroic conditions of 

 existence. As the facts have accumulated 

 and the methods of these newer sciences 

 have been elaborated, it has become in- 

 creasingly more difficult for one with 

 divided interest to understand and partic- 

 ularly to add to them. Twenty-five years 

 ago the professor of anatomy was a sur- 

 geon; the professor of pathology a practi- 

 tioner of medicine. These men were often 

 able and brilliant teachers of subjects which 

 were their avocations rather than their true 

 professions. They were even contributors 

 to sciences which in their incompleteness 

 made the finding of new facts easy. As the 

 mass of acquired facts became larger, the 

 gaps between them shorter but more diffi- 

 cult to fill, and the stimulus to further dis- 

 covery greater, men one after another 

 slipped from the beaten track of practise to 

 become laboratory workers, usually at a 

 financial sacrifice, because the work ap- 

 pealed to them. 



It became evident that the medical sci- 

 ences require whole-souled devotion. As 

 Dietl expressed it in 1851, 



As long as medicine remains an art it will not be 

 a science. As long as there are only successful 

 physicians there will be no scientific physicians. 



It is the practitioner, however, who has 

 created the field for this latter type of 

 worker and who, to a large extent, has made 

 his existence possible. 



We have had then for a number of years, 

 two types of workers in medicine — the labo- 

 ratory man and the practitioner; the 



