Some Discursive Remarks on Bedside Diagnosis *

When Doctor Phillips asked me to talk to you on bedside diagnosis I surmised that you had chosen this topic not because I happened to have edited the work commonly known around New Haven as the "Bedtime Stories", but because its real title, Bedside Diagnosis, suggested that I entertained certain view-points regarding diagnosis in particular and clinical medicine in general with which, perhaps, you are in sympathy. Those of you who have dipped into the Bedside Diagnosis will recall that the introductory chapter is preceded by two quotations which will serve well enough as texts on which to hang the content of this discourse. The first quotation is from the writings of the eminent Edinburgh clinician and teacher, Byrom Bramwell, and is to the effect that "the only real knowledge of disease is that which is acquired at the bedside by careful and minute observation of the living patient." The other quotation, from an article by Professor Alfred Stengel, of the University of Pennsylvania, calls attention to the appearance, coincident with the rapid development of accurate scientific methods, of a feeling of disregard, if not contempt, for the older, purely clinical methods. I need hardly remind you that the remarks of these gentlemen refer to the practice of medicine and that both, far from decrying the value of laboratory methods, firmly believe that, properly used, these procedures are of incalculable value. Let us begin this discussion then by inquiring first, why it should be necessary for Dr. Bramwell to insist so emphatically on the urgent