t eye-and-hand examination of our
patients than the doctor of a century ago, we can tell three to five
times as much. Signs that he could interpret only by the slow and
painful method of two-thirds of a lifetime of plodding experience, or by
occasional flashes of half-inspired insight, we are now able to
interpret absolutely upon a physiological--yes, a chemical--basis from
the revelations of the microscope, the test-tube, and the culture
medium. His only way of determining the meaning of a particular tint of
the complexion, or line about the mouth, or eruption on the skin, was by
slowly and laboriously accumulating a long series of similar cases in
which that particular symptom was found always to occur, and deducing
its meaning. Now, we simply take a drop of our patient's blood, a
scraping from his throat, a portion of some one of his secretions, a
little slice of a tumor or growth, submit them to direct examination in
the laboratory, and get a prompt and decisive answer.

The observant physician begins to gather information about a patient
from the moment he enters the sick-room or the patient steps into his
consulting-room; and the value of the information obtained in the first
thirty seconds, before a word has been spoken, is sometimes
astonishingly great. While no intelligent man would dream of depending
upon this first _coup d'[oe]il_, "stroke of the eye" as the French so
graphically call it, for his final diagnosis, or accept its findings
until he had submitted them to the most ruthless cross-examination with
the stethoscope and in the laboratory, yet it will sometimes give him a
clew of almost priceless value. It is positively uncanny to see the
swift, intuitive manner in which an old, experienced, and thoughtful
physician will grasp the probable nature of a case in one keen look at a
patient. Often he can hardly explain to you himself how he does it, what
are the data that determine it; yet not infrequently, three times out
of five, your most elaborate and painstaking study of the case with all
the modern methods will bring you to the same conclusion as that sensed
within forty-five seconds by this keen-eyed old sleuth-hound of the
fever trails. Time and again, in my interne days, have I gone the rounds
of the wards or the out-patient departments with some kindly-faced,
keen-eyed old Sherlock Holmes of the profession, and seen him point to a
new case across the ward with the question: "When did that pneumonia