17 , i Ash: The Physician and the Laboratory 49 
George in this case being the laboratory. The doctor will have 
a case that may not be obvious to the superficial examination he 
is willing or able to give it, so he sends some blood or urine or 
feces, or maybe all of them, to the laboratory in the hope that a 
positive report of something or other may be forthcoming and 
on that report he will pin his faith and it will constitute the 
basis for his handling of the case without further particular 
study on his part. Why should he worry further about the 
diagnosis? Did the laboratory not report a positive Wasser- 
mann? “My duty, therefore, ends in a course of treatment for 
syphilis,” he argues. The pathologist says the hemoglobin is 
low. “Why worry about the possibilities? I’ll just give some 
iron or tonics.” Hookworm eggs were found. “That simplifies 
things considerably. I can kill the worms and all will be well,” 
he says, not stopping to think that perhaps the pathologist has 
been particularly diligent and has spent a great deal of time 
in finding one or two ova and that, while hookworms are not 
particularly desirable guests, one ovum in the stools no more 
makes a case of ankylostomiasis than one swallow makes an 
inebriate. The evil of the laboratory, therefore, is to dull the 
natural senses of the doctor and develop in him a false sense 
of security and a degree of dependence that is not healthy. 
Can the doctor interpret the reports he receives? This is a 
very important phase of the question. Does he know enough 
about laboratory work to appreciate its limitations? Does he 
know the grade of work, the extent of experience, training, and 
honesty of the man who is doing his work? Or is he satisfied 
to receive a piece of paper that has on it something definite that 
he can show the patient, without regard to its accuracy? Much 
depends on these factors and they must be seriously considered 
by the clinician. It is as much an obligation on the doctor to 
select the right laboratory as it is to choose the competent sur- 
geon or other specialist, for the patient depends on his judgment 
as much in the one instance as in the others. 
Granted the doctor knows when to call on the laboratory for 
help, and granted that the laboratory work he is getting is 
dependable, can he, as asked before, properly interpret the 
reports he receives and give them their proper significance? 
It is here particularly that there should be close cooperation 
between the two. I claim that the pathologist should know 
enough clinical medicine to appreciate his relations to it. He 
should be more than a mere technician. He cannot report in- 
174675 — 4 
