50 The Philippine Journal of Science 1920 
telligently unless he has a broad grasp through knowledge and 
experience of the clinical side of the case, and can discuss the 
pros and cons intelligently with the clinician. 
You must appreciate that it is not always possible to give a 
cut-and-dried report on a specimen. It is not much more possible 
to do this than it is for you to give the dogmatic diagnosis that 
your patient demands. We cannot always be dogmatic and 
accurate at the same time. It is often necessary to qualify the 
laboratory diagnosis, just as it is necessary for you to qualify 
and hedge on your clinical opinion of the case, often, and I might 
say usually. With some knowledge of the case the laboratory 
can often suggest an appropriate examination to be applied. I 
know that the chief reason for keeping the case a secret from 
the pathologist is to prevent a prejudiced or doctored diagnosis, 
but the danger from this is more than compensated for by the 
more intelligent examination and the benefit that the closer co- 
operation is bound to have on the outcome of the case. 
Does the physician further know enough about a laboratory 
to enable him to send his specimens in proper condition? Does 
he know that a hemolyzed or old infected serum is not satis- 
factory for the Wassermann test and will probably be anticom- 
plementary ; that a cold stool is unsatisfactory material in which 
to find amoebae ; that a cell count on the spinal fluid must be done 
at the bedside to be at all accurate ; that hyalin casts will disin- 
tegrate in an old specimen of urine? The responsibility for ac- 
curate laboratory work is not entirely with the pathologist. 
The laboratory has very distinct limitations that you must 
realize. It cannot manufacture a diagnosis for you out of whole 
cloth, nor can it always make its findings fit in with your idea 
of what they should be. It cannot take the place of skilful and 
careful bedside study. You must realize that a negative re- 
port does not as a rule mean very much. Of course its signif- 
icance is in direct proportion to the skill and care of the man 
who makes it. A negative report is usually very unsatisfactory 
to both the doctor and the pathologist, because it does not help 
the former very much and means a great deal more work for 
the latter. You know, the pathologist develops a sort of per- 
verted moral sense. A positive specimen usually gives a pe- 
culiarly devilish sort of satisfaction to him, despite the meaning 
it may have for the poor patient. There is a certain amount 
of glee attached to finding tubercle bacilli in the sputum right 
off the bat, or being able to demonstrate amoebae in the stool 
simply by focusing the microscope. For this spirit, of course, 
