A physician’s subject of study is necessarily the patient, and his first field for observation is the hospital. But if clinical observation teaches him to know the form and course of diseases, it cannot suffice to make him understand their nature; to this end he must penetrate into the body to find which of the internal parts are injured in their functions. That is why dissection of cadavers and microscopic study of diseases were soon added to clinical observation. But to-day these various methods no longer suffice; we must push investigation further and, in analyzing the elementary phenomena of organic bodies, must compare normal with abnormal states. We showed elsewhere how incapable is anatomy alone to take account of vital phenenoma, and we saw that we must add study of all physico-chemical conditions which contribute necessary elements to normal or pathological manifestations of life. This simple suggestion already makes us feel that the laboratory of a physiologist-physician must be the most complicated of all laboratories, because he has to experiment with phenomena of life which are the most complex of all natural phenomena.

As soon as we got rid of the backroom attitude and brought our apparatus fully into the Department with an inexhaustible supply of living patients with fascinating clinical problems, we were able to get ahead really fast. Any new technique becomes more attractive if its clinical usefulness can be demonstrated without harm, indignity or discomfort to the patient... Anyone who is satisfied with his diagnostic ability and with his surgical results is unlikely to contribute much to the launching of a new medical science. He should first be consumed with a divine discontent with things as they are. It greatly helps, of course, to have the right idea at the right time, and quite good ideas may come, Archimedes fashion, in one's bath..

AZT stood up and said, 'Stop your pessimism. Stop your sense of futility. Go back to the lab. Go back to development. Go back to clinical trials. Things will work.'
[On the impact of AZT emerging as the long-sought first significant AIDS drug.]

Clinical ecology [is] a new branch of medicine aimed at helping people made sick by a failure to adapt to facets of our modern, polluted environment. Adverse reactions to processed foods and their chemical contaminants, and to indoor and outdoor air pollution with petrochemicals, are becoming more and more widespread and so far these reactions are being misdiagnosed by mainstream medical practitioners and so are not treated effectively.

Clinical science has as good a claim to the name and rights and self-subsistence of a science as any other department of biology.

In clinical investigation the sick individual is at the centre of the picture. The physician must have a deep interest in his patient’s economic and social structure as well as in his physical and psychic state. If attention is not paid to the diagnosis of the person the clinical investigator is apt to fail in studies of the patient’s disease. Without a consideration of the patient as a human being it would have been difficult to have fed patients daily large amounts of liver.

Inexact method of observation, as I believe, is one flaw in clinical pathology to-day. Prematurity of conclusion is another, and in part follows from the first; but in chief part an unusual craving and veneration for hypothesis, which besets the minds of most medical men, is responsible. Except in those sciences which deal with the intangible or with events of long past ages, no treatises are to be found in which hypothesis figures as it does in medical writings. The purity of a science is to be judged by the paucity of its recorded hypotheses. Hypothesis has its right place, it forms a working basis; but it is an acknowledged makeshift, and, at the best, of purpose unaccomplished. Hypothesis is the heart which no man with right purpose wears willingly upon his sleeve. He who vaunts his lady love, ere yet she is won, is apt to display himself as frivolous or his lady a wanton.

Nowadays the clinical history too often weighs more than the man.

Our laboratory work involved close contact with many non-clinical scientists. Sir Peter Medawar, 1960 Nobel Laureate, was a frequent visitor to our lab and to the hospital. He once commented, after visiting an early renal transplant patient, that it was the first time he had been in a hospital ward.

Rudolf Virchow, often referred to as the father of modern pathology, broke sharply with such traditional concepts by proposing that the basis of all disease is injury to the smallest living unit of the body, namely, the cell. More than a century later, both clinical and experimental pathology remain rooted in Virchow’s cellular pathology.

The air of caricature never fails to show itself in the products of reason applied relentlessly and without correction. The observation of clinical facts would seem to be a pursuit of the physician as harmless as it is indispensable. [But] it seemed irresistibly rational to certain minds that diseases should be as fully classifiable as are beetles and butterflies. This doctrine … bore perhaps its richest fruit in the hands of Boissier de Sauvauges. In his Nosologia Methodica published in 1768 … this Linnaeus of the bedside grouped diseases into ten classes, 295 genera, and 2400 species.

The only sure foundations of medicine are, an intimate knowledge of the human body, and observation on the effects of medicinal substances on that. The anatomical and clinical schools, therefore, are those in which the young physician should be formed. If he enters with innocence that of the theory of medicine, it is scarcely possible he should come out untainted with error. His mind must be strong indeed, if, rising above juvenile credulity, it can maintain a wise infidelity against the authority of his instructors, and the bewitching delusions of their theories.

The statistical method is required in the interpretation of figures which are at the mercy of numerous influences, and its object is to determine whether individual influences can be isolated and their effects measured. The essence of the method lies in the determination that we are really comparing like with like, and that we have not overlooked a relevant factor which is present in Group A and absent from Group B. The variability of human beings in their illnesses and in their reactions to them is a fundamental reason for the planned clinical trial and not against it.

The understanding of a complex problem such as atherosclerosis requires the tools of basic science. We are fortunate to live at a time when the methods of basic science are so powerful that they can be applied directly to clinical problems. … [T]he two attributes that are required – basic training and technical courage.

These hormones still belong to the physiologist and to the clinical investigator as much as, if not more than, to the practicing physician. But as Professor Starling said many years ago, 'The physiology of today is the medicine of tomorrow'.

This is my religion: I am filled with Wonder at the outcome of 4 billion years of evolution here on our speck in the universe and Hope regarding our opportunity to improve the lives of those around us through basic science discoveries and their translation to clinical practice.

When you're talking deaths in clinical trials, mistakes are not an option. It's just an area where we have to have absolute, foolproof reporting in place.

While up to this time contrary sexual instinct has had but an anthropological, clinical, and forensic interest for science, now, as a result of the latest investigations, there is some thought of therapy in this incurable condition, which so heavily burdens its victims, socially, morally, and mentally. A preparatory step for the application of therapeutic measures is the exact differentiation of the acquired from the congenital cases; and among the latter again, the assignment of the concrete case to its proper position in the categories that have been established empirically.