494 



SCIENCE 



[N. S. Vol. XXXYIII. No. 980 



yield that primacy because she k^iows what 

 is good for her." Many excellent men have 

 been trained in Welch's laboratory and 

 through them, as well as through pupils of 

 Prudden, pathology is well taught in the 

 better American schools. One very great 

 handicap to medical progress lies in the 

 laws relating to the autopsy of the hospital 

 dead. In the seventies, when E. G. Jane- 

 way and Francis Delafield were laying the 

 foundation of their masterful comprehen- 

 sion of the science of medicine, it was easy 

 for them to follow the course of disease 

 and see the results at autopsy if the pa- 

 tient died. But now the New York law 

 forbids an autopsy without consent of the 

 next of kin, instead of accepting the more 

 rational plan of permitting autopsy unless 

 objection is offered within twenty-four 

 hours by the next of kin. The difficulties 

 to be overcome before an autopsy is al- 

 lowed are such that only 10 per cent, of 

 the patients dying in Bellevue Hospital, 

 with its twelve hundred beds, are actually 

 autopsied. A grotesque reflection upon 

 this foolish system is shown in the fact that 

 these 10 per cent, of autopsies indicate in- 

 correct diagnosis in a large percentage of 

 the cases. The following is the record in 

 one large public hospital of 390 autopsies 

 in the year 1912, as compiled by Oertel. 



Per 



Cases Cent. 



Clinical diagnosis confirmed 87 22.3 



Clinical diagnosis correct but important 



additional lesions found 116 29.7 



Clinical diagnosis partly correct 54 13.8 



Clinical diagnosis not confirmed 109 27.9 



No clinical diagnosis 24 6.3 



390 100.0 



If the physician were sure that, in case 

 of death, his diagnosis would be checked by 

 the pathologist, he would be likely to exer- 

 cise greater care in his work, and he and 

 his pupils would learn to better understand 

 the limitations of diagnosis. Also, the value 



of vital statistics would be immeasurably 

 enhanced. 



This very ill-advised policy on the part 

 of the law-making power has had a further 

 effect of diseoiiraging pathological mor- 

 phology, so that many pathological labor- 

 atories have turned attention to experi- 

 mental pathology or experimental medicine, 

 for which latter separate departments have 

 sometimes been instituted. The enforced 

 neglect of morphological pathology has 

 been a grave obstacle in the path of medical 

 progress. 



THE SECOND TWO YEARS OP THE MEDICAL 

 COURSE 



For thirty years, it has been possible to 

 train laboratory workers in the medical 

 sciences according to the best principles, 

 and in increasing measure both men and 

 opportunity have been developed. It 

 seems passing strange that, with aU this 

 activity, it is only very recently that the 

 clinical situation has been touched. Men 

 have passed through the schooling of the 

 laboratories, and then, for two final years 

 of education, have been, and usually still are, 

 turned over to clinicians the majority of 

 whom have had no laboratory training, and 

 the student has graduated, and still grad- 

 uates, without knowing the application of 

 the fundamental medical sciences to the 

 practise of his profession. Halliburton 

 has epitomized the situation in the words, 

 "The student forgets his physiology at the 

 bedside." It is well for the clinician to 

 assure the teachers of the fundamental sci- 

 ences that they do best when they emphasize 

 the importance of the practical application 

 of their scientific knowledge, but this is 

 only half the story. The more important 

 half lies in the necessity that the clinical 

 teacher should know in what way the 

 fundamental sciences are helpful in the 

 understanding of medicine. 



