November 10, 1911] 



SCIENCE 



621 



provincial and state authorities of labora- 

 tories more or less well-equipped for aiding 

 the busy practitioner in his problems of 

 service to his patients. Private labora- 

 tories for the same purpose exist in many 

 places, where for reasonable remuneration 

 all sorts of tests and examinations are car- 

 ried out. In not a few instances men with 

 large practises employ in their offices of 

 consultation skillful persons, usually recent 

 graduates, who render prompt and efficient 

 service in clinical diagnosis. 



IV. As a place of experiment and re- 

 search, I feel that in the highest degree the 

 laboratory more than justifies its existence. 

 It constitutes the great testing-shop of ideas 

 and theories, either generated within its 

 walls as the result perhaps of previous ex- 

 periment, or of those coming to it from 

 beyond, the rasults of which may at once 

 be made available for application in the 

 clinical field. 



As previously pointed out, medicine is no 

 longer confined within narrow bounds, but 

 constitutes a field of activity so wide as to 

 demand the assistance of the other sciences 

 to help solve its problems. And realizing 

 full well that in this day and generation of 

 progress in knowledge no one man is 

 capable of becoming an expert in all of the 

 sciences, we are in consequence witnessing 

 medical research develop in complex form ; 

 where laboratories are established for re- 

 search in physiology, pathology, chemistry, 

 sanitary science and the like — attached to 

 or entirely apart from the organization of 

 medical school or university. 



And so profoundly has the development 

 of the laboratory in late years affected the 

 course of medicine abroad, particularly in 

 Germany, that that "holy of holies" of the 

 clinicians, the hospital ward, is regarded as 

 a laboratory of research, as it essentially is 

 and properly should be. There the pro- 

 fessor of medicine and his chief assistants 



are both excellent clinicians and excellent 

 laboratory workers ; their duties to the hos- 

 pital markedly limit or abolish private 

 practise and leave ample time for carrying 

 out instruction and research. In the 

 United States the same development has, 

 begun; witness the establishment of the 

 hospital in connection with the Rockefeller- 

 Institute for Medical Research, where dis- 

 eases of all sorts may be intensively studied 

 by combined clinical and scientific methods, 

 the right of remunerative practise being 

 denied the staff. At the present moment, 

 too, the authorities of the Johns Hopkins 

 University, appreciating the great value of 

 this movement in modern medicine, are 

 formulating plans whereby the heads of aU 

 the clinical branches be denied the right of 

 private practise and be required to confine 

 their whole attention to the development of 

 ward material for purposes of instruction 

 and research. 



Reading then the signs of the times cor- 

 rectly, it appears that medicine has now 

 entered upon a new and profitable era; 

 upon a period of development wherein the 

 scientific or laboratory idea is effecting a 

 cleavage in the clinical field both in its 

 methods and in its personnel. Revolu- 

 tionary as it may now seem, the clinical 

 branches in our teaching institutions in 

 the future will probably be most largely 

 filled by those who are at the same time 

 competent clinicians and carefully trained 

 workers in one or other line of scientific 

 research, devoting most of their time to 

 instruction and investigation and less or 

 none to the distractions of private practise. 



At this juncture I do not wish to be 

 adjudged as one who is engaged in belit- 

 tling the efforts of the clinical professor, 

 past or present; that would be wickedly 

 unjust, but I do believe that the time has 

 come when not to acknowledge this evolu- 

 tionary trend in clinical medicine is to 



