Doctor and patient : $b Papers on the relationship of the physician to men and institutionsPeabody, Francis Weld
Science
Doctor and patient : $b Papers on the relationship of the physician to men and institutions
Peabody, Francis Weld
Medicine; Medicine -- Practice; Physicians
The laboratory tests which should be at the command of every
practitioner of medicine are those which deal with the more important
and practically useful examinations of the blood, urine, feces, gastric
contents, spinal fluids, pleural and ascitic fluids. These are the
tests that are customarily taught in the medical schools in the course
in clinical pathology, and the instruction is usually designed to
take up the laboratory methods that are absolutely necessary for good
practice and those only. An experience in teaching this subject during
the last seven years has emphasized the striking fact that in spite
of the great contributions which the laboratory has made to clinical
medicine there has been surprisingly little change in the character or
number of the technical methods which are essential for good practice.
In many instances the progress of medical science has resulted in a
clearer, broader, and more helpful interpretation of the tests, but
the actual technical procedures have not been greatly altered and they
are still available to the trained man who has a minimum of laboratory
apparatus. It has, indeed, been interesting to find how little new
material in the way of technical procedure could justifiably be added
to the course from year to year, even though the literature and the
practices of various clinics were carefully followed in the attempt
to keep the course up to date. The methods for the examination of the
urine, for instance, are taught much as they were two decades and more
ago. Certain tests, such as urea determinations, have been discarded
and others are regarded as having a different significance, but the
records still show the color, specific gravity, reaction, albumin and
sugar content, and the microscopic examination of the sediment. These
simple observations, correctly used and interpreted, are practically
all that is necessary in cases of nephritis. The modern “two hour renal
test” requires nothing more than determinations of volume and specific
gravity, and if it is combined with the phenolsulphonephthalein
test--the technique of which is entirely simple--the field is open for
the study of renal function. It is far more important to understand
the significance of these easy tests than it is to worry about the
quantitation of blood urea or blood uric acid. The situation is much
the same with regard to hematology. The technical procedures of primary
value are now as they have been for years, the counting of white cells
and red cells, the estimating of hemoglobin, and the preparation of
stained specimens of blood. Quite recently the students at the Harvard
Medical School have also been instructed in the methods of counting
platelets and of staining reticulated cells, but neither of these
procedures involves any essentially new technique. With these, and one
or two other tests, such as coagulation time and bleeding time, the
field of hematology is open. Again, the technique has been altered but
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