Page:Hospitals, medical science and public health.djvu/13

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AND PUBLIC HEALTH

than moderate sums allotted to investigation by young men of scientific ardour whose education in method is fairly adequate. If it does little more than keep the junior staff and their pupils active, curious, and attentive, the outlay has its ample reward.


Clinical Pathology.

And thus I am led, not merely to urge in general terms the alliance of clinical medicine with scientific research, for this is a counsel not needed in Manchester, but to advocate in particular a far closer intimacy and cooperation than at present exist between the physician and the pathologist. Since a few of us, some years ago, began to urge the creation of clinical laboratories close to the doors of the wards, a little has been done no doubt; but in most places it has been done, in my opinion, awkwardly and very partially. Herein I think the medical manager, as sinning against the light, is more to blame than the lay; so that the pathologist—I speak not now of morbid anatomy which has long enjoyed every advantage, but of pathology in its dynamic aspect—the pathologist in this sense is kept aloof from the patient whose processes it is his main business to interpret; and the physician, with morbid anatomy nearer his elbow, has been losing something of the sense of disease as dynamics, which, with all their fantasies of vapour and humour, was apprehended by our ancestors of the last two or three centuries. Of late years a remarkable integration has begun, and is rapidly proceeding, between anatomy and physiology; and, if medicine is to advance as it has been advancing, the same integration must be created between static pathology, medical practice, and dynamic pathology—the pathology of processes. That the pathologist must investigate the sick man in whose body these defects and perversions are at work seems too obvious for assertion; yet when some few months ago I asked, somewhat ironically I fear, of a distinguished pathologist in a great university if he had free access to the wards of the hospital, he replied, "If I were to set foot in the wards there would indeed be a pretty hubbub in the staff." So the pathologist, at arm's length in a laboratory down the street, working, as it were, in a balloon, and fed upon occasional crumbs from the hospital table, never sets eyes upon the concrete problems which it is his business to solve. There