Page:Carnegie Flexner Report.djvu/110

92 a serious question of professional etiquette, who should speak first or loudest,—the pathologist, armed with his microscope, or the clinician, brandishing his stethoscope. To parallel the dispute, one must go back to the two knights who, meeting at a cross-road, disputed at the hazard of their lives as to the color of a shield which, as neither had stopped to reflect, had two sides. It is as profitable to discuss which was the right side of the shield as to raise the question of precedence between the laboratory and the bedside. Both supply indispensable data of coördinate importance. The central fact may be disclosed now by one, now by the other, but in either case it must be interpreted in the light of all other pertinent facts in hand. The scientific character of the procedure depends not on where or by what means facts are procured, but altogether on the degree of caution and thoroughness with which observations are made, inferences drawn, and results heeded. The essence of science is method,—the painstaking collection of all relevant data, the severe effort to read their significance in connection. These objects are promoted in some directions by the laboratory appliances that eke out our defective senses; even so, however, we do not escape or rise superior to these same senses; for with them we use the implements in question. Whatsoever, then, the senses actually ascertain, pertinent to the matter in hand, is scientific datum. The way to be unscientific is to be partial,—whether to the laboratory or to the hospital, it matters not. The test of a good education in medicine is the thorough interpenetration of both standpoints in their product, the young graduate.

If, then, a laboratory is a place constructed for the express purpose of facilitating the collection of data bearing on definite problems and the initiation of practical measures looking to their solution, the hospital and the dispensary are laboratories in the strictest sense of the term. And just as it makes no difference to science whether usable data be obtained from a slide beneath a microscope or from a sick man stretched out on a cot, so the precise nature of the act or experiment is equally immaterial: it matters not in the slightest, from the standpoint of scientific logic, whether the step take the form of administering a dose of calomel, operating for appendicitis, or stimulating a particular convolution of a frog's brain with an electric current. The logical position is in all three cases identical. In each a supposition,—whether expressed or implied, whether called theory or diagnosis,—based on supposedly adequate observation, submits itself to the test of an experiment. If proper weight has been given to correct and sufficient facts, the experiment wins; otherwise not, and a second effort, profiting by previous failure, is demanded. The practising physician and the “theoretical" scientist are thus engaged in doing the same sort of thing, even while one is seeking to correct Mr. Smith's digestive aberration and the other to localize the cerebral functions of the frog.

Certain conclusions as to clinical teaching follow. The student is to collect and evaluate facts. The facts are locked up in the patient. To the patient, therefore, he must go. Waiving the personal factor, always important, that method of clinical teaching