The most significant pattern in the history of American biochemistry prior to 1940 is its close connection to clinical medicine. The first generation of American biochemists to acquire international reputations were known for their achievements in clinical biochemistry; for example, Otto Folin, Stanley Benedict, and D. D. Van Slyke. Most departments of biochemistry were in medical schools and their prosperity depended on their service roles in medical instruction and clinical research in hospital laboratories and research wards. Biochemists regarded clinical medicine as a crucial source of important and fundable research problems, employment for their students, and political support for their profession.

This view may appear to contradict the idea, developed in Chapter 7, that biological chemists liberated themselves from clinical medicine in the period of reform. The drama of succession should not distract us from the underlying continuity. Biochemists freed themselves from a particular kind of relationship only to reestablish the relationship on a new basis. What had been either a hybrid or dependent role became a more or less equal partnership. In the process, clinicians as well as biochemists were obliged to adapt their disciplinary ideals.

As long as there was little opportunity for medical chemists to build a specialized discipline, there was no great problem of reconciling divergent disciplinary goals. Many of the old medical chemists were clinicians, so no role conflict existed there. The rest were applied chemists, who practiced their profession in a context dominated by clinicians and seldom doubted the propriety of clinicians calling the tune.