Theobald Smith

“ Perhaps, next to the education of physicians of the highest standards, the immediate duty of the university medical school is the development through research of preventive medicine and sanitary science and the education of sanitary officers. This, it seems to me, is the best way in which our debt to society can be discharged; for it is the way through which medicine has moved during the past quarter century to its present commanding position; it is, in fact, the way of least resistance for the human race to evade or mitigate the penalty incidental to advancing civilization. ”

“ Passing now to the more obvious external conditions which have tended to stimulate medical research, we may single out a few which have been of special importance. Perhaps the most ancient and strongest of all is the desire in the human breast to maintain health and prolong life. From its very beginnings the healing art has been weighed down with the greatest of problems, to save life and to cure disease, often in those of lofty estate, and its status for the time being frequently depended on its success or failure in accomplishing apparently the impossible. ”

“ As I stated before, the knowledge of the world is covered with the froth of research fermentation of several years' depth, and the latter yields about as much genuine knowledge as the froth does actual fluid. The teacher can not well sound its depths unless he has made some independent studies of his own. Then he will be able to say something definite, whether he has been at work in this very field or not. His critical view will enable him to take sides and be positive rather than negative in his teaching. ”

“ The spirit of research should be properly tempered by a true insight into the relation of enquiry to the great accumulation of knowledge and the reserve forces stored in the every-day experience of mankind and handed down from generation to generation.
In the meantime the optimism of the world which unknowingly assumes that medical science can rise above natural law and correct any and all excesses of individuals and communities must be met by a better education in natural science rather than abandoned to the manipulations of the charlatans of physical and mental healing. ”

“ Such men should have medical training and approach their problems from the medical point of view; but to them should be spared the necessity of learning ultimate details of the medical art and they should give their energy to some sister study, be it morphology, physiology, chemistry or pathology. Medicine has just begun to realize the need of drawing to itself the great talent which hitherto has had an open door only to the pure and applied sciences. ”

“ When in practice he is disturbed by the confusion of voices, which, like the will-o'-the-wisp, lead neither here nor there, or when he is perplexed by the movement of fads and fashions pointing now in one, now in the diametrically opposite direction, when he comes to realize that much of his professional work is still empiricism and that it moves from precedent to precedent, he will look back upon his best laboratory work with a feeling of relief and recognize in it the germs of the science of medicine where his results came true if he worked accurately, and where he could predict the outcome. ”

“ There the days, months and years of disease processes must be concentrated into minutes and hours. Much of the laboratory work is like the ward visit, a fragment, to be pieced out through the agency of books, lectures and the imagination. ”

“ This has not always been the attitude of medicine, for standing as it does under the too near and impending shadow of suffering and death, it was but natural to attack the most difficult and complex problems first.
It is needless to say that the position of the research worker of the immediate future will not be an easy one. The strain to produce something is far more wearing than teaching. The mental play of the teacher's mind to produce something is relaxation compared with that of the investigator to carry out a contract for the delivery of new knowledge. ”

“ As a most important and timely contributory force to the advancement of medical research in recent years are the princely gifts of benefactors, with whom we especially associate the names of Johns Hopkins, Garrett, Fabyan, Rockefeller, McCormack, Payne, Morgan, Huntingdon, Sears, Stillman, and many others without whose aid medical research could hardly have commanded a corporal's squad today.
A factor not to be neglected in the advancement of medical science is the feeling of national pride. ”

“ The teacher who is called upon to direct the work of students who are beginning to feel their way into unknown territory or who have already left the beaten path far behind must of necessity be an investigator. Without going ahead of them himself his counsel is apt to be wavering and at times he feels himself wholly helpless to advise. In other words, to direct research the teacher must be playing the chief part while his students, of whatever rank, should take subordinate parts all definitely working toward a given end. ”

“ Such is frequently the mission of the true discoverer, to leap over mounds of facts and figures, bring us back close to nature and show us that her movements are often far simpler than we dared imagine.
Thus far I have dealt with research as a thing by itself to be furthered by endowment and prosecuted by specially fitted men for the sake of its value to mankind. ”

“ The physician can not control his patient excepting within a narrow range. Experiment as such, except when of a trivial nature, is forbidden by law and conscience. Statistics is the only court of appeal he has in attempting to prove success, and this method we know is open to serious error. On account of his peculiar and unique life work, the physician must build his education as broadly as possible and carry as much information as is compatible with normal thinking. The research worker, on the other hand, digs and delves and he must leave unnecessary encumbrances behind. ”

“ Research begets new data and the opposition to these begets new research. Thus the fermentation is kept up and a froth several years deep lies on the surface which few can penetrate.
This haste and hurry is part and parcel of what might be called nature's lavish waste of energy. The volume of our information increases more rapidly than our knowledge of the principles which underlie and support it. The progress actually made is more apparent than real. ”

“ Perhaps the most important acting from within has been the use of animals. The study of the great domain of infectious diseases has revealed such a similarity between the diseases of man and the higher animals that we hesitate now less than before to apply courageously the knowledge gained in our experiments upon the highest mammals to human physiology and pathology. Without this aid from animal life, medicine as a progressive experimental science would dwindle into insignificance. ”

“ With the growth of the cost of research it becomes of great importance to exercise care and selection in admitting men to research positions. Fortunately there are not many collateral attractions in a life of research and the process of elimination acts as a rule automatically. Still there is danger just now that some of the flotsam and jetsam caught in an eddy or else afraid of the current of practical life may seek the quiet of the laboratory, because of some imagined taste or capacity which fails to materialize later on. It is far better not to have any research workers than poor ones. ”

“ If a teacher remains sterile both in himself and his students he has missed his vocation.
Of importance equal to that of an efficient body of teachers are adequate laboratory facilities both for teaching and research. Medical science has moved beyond that stage when a student could be kept profitably employed with a microscope and a box of slides. With the growth of laboratory methods of diagnosis, more varied and costly apparatus is needed, more space to place it and more laboratory service to guard it. ”

“ The founding of research institutes does not guarantee their success. That will depend upon the men who work in and for them. It has become evident that our research workers must have more diversified training than the older generation possesses. The store of knowledge accumulated by science must be made available to medicine. The only way in which this can be accomplished is to have trained men continually examining and testing this accumulating store of facts and applying them to the problems of disease. ”

“ It also means effort directed toward the more efficient and economical application of discoveries to the welfare of man, in other words, the utilization of latent and hitherto wasted energy. The aims of research are not culture, not miscellaneous information, not a mood of leisure meditation upon the origin of things, but mainly utility and service to mankind.
The chief influence at work in lifting medicine from a mere teaching to a research level is the same as that at work throughout the world of science and in fact in all intellectual fields. ”

“ The medical profession is in a sense to blame for this condition; for the household remedies and cures of to-day are those of the doctor of a generation ago, and the medical practise of to-day will crop out in the daily life of the next generation. Likewise, the indifference of the physician and health officer of a generation ago is reflected today in the attitude of the mass of the people. ”

“ Much of what is taught to-day in pathology belongs to clinical medicine and surgery, for it is largely special and diagnostic in character. The pathologist is now the servant of the physician and surgeon in completing and rectifying their diagnoses. The pathologist of the future will deal with more general phenomena derived from experimental and comparative data, just as the physiologist has moved onward, or backward if you please, into general and comparative physiology. ”

“ In the historical development of science the research instinct appeared at first sporadically, and until recently it was simply the spontaneous flowering of the scholarly mind in the highest institutions of learning. To-day it has been actually organized not so much to train youth as to produce useful knowledge. This new organization of research has been greatly favored by the promise of valuable returns in the suppression of infectious diseases of man and animals. ”

“ The relatively large endowments given to medical education and research in recent years have created as it were a trust to be administered by the medical profession in the interest of human society in the broadest and highest significance of the term. This I interpret to mean that we must endeavor to make all advance in our knowledge of health and disease common property so far as this may be possible, to disseminate broadcast the benefits of research into the laws of health, so that they may enter into and form an integral part of the life of the individual and the community. ”

“ Like the driftwood of which the waves are endeavoring to unburden themselves, many excursions back and forth must be made before the fact is finally landed. It is often much battered and barely recognizable. ”