OCTOBEB 22, 1909] 



SCIENCE 



543 



admission to the medical department here 

 at Stanford, what preparation should the 

 faculty seek to give its students for a career 

 in medicine? It is evident that if, as I 

 have pointed out, the career of medicine 

 offers several possibilities for life-work, the 

 medical school must furnish a certain elas- 

 ticity of preparation. However, you must 

 recognize first of all that by far the larger 

 number of your students will become gen- 

 eral practitioners and the world at large 

 will judge the success of your medical 

 school by the type of general practitioner 

 you send out. To the casual observer a 

 medical school is merely a place for train- 

 ing men for the practise of medicine— it is 

 to them a technical school, not a imiversity 

 department. So you must seek to train 

 your men for this part of the career of 

 medicine as well as it is possible. On them 

 will rest a great responsibility— the respon- 

 sibility of giving to their fellows the best 

 that modern medicine has to offer in pre- 

 venting disease, in mitigating its pains and 

 in curing its attacks. With a broad knowl- 

 edge of medicine as a biologic science, with 

 an intimate knowledge of the normal and 

 abnormal mechanism of mind and body, 

 with a rational grasp of all forms of thera- 

 peusis and a thorough training in the diag- 

 nostic methods of medicine, you must pre- 

 pare your students for this responsibility. 

 There will, of course, be laboratories and 

 clinics with adequate equipment, represent- 

 ing an investment of many thousands of 

 dollars. Men to man these you will secure, 

 choosing the best in the land, for after all, 

 men more than buildings are the particular 

 pride of universities. 



The organization of the departments 

 giving instruction in the first two years of 

 the medical curriculum is easier to-day 

 than of those dealing with the later years, 

 the clinical instruction. In our medical 

 schools there is more uniformity of instruc- 

 tion in anatomy, physiology, chemistry, 



pathology and bacteriology than in the 

 other branches of the medical course, and 

 I believe good instruction is more generally 

 given in these. One reason for this is that 

 the necessary money is the only limitation 

 to the possession of satisfactory labora- 

 tories and to obtaining competent men for 

 these subjects. Sufficient material for in- 

 struction is usually quite easily obtained. 

 On the other hand, to the satisfactory de- 

 velopment of clinical instruction condi- 

 tions in American medicine have furnished 

 many obstacles- obstacles which I trust 

 this university is to take an active part in 

 removing. For satisfactory^ efficient clin- 

 ical teaching ho.spitals are absolutely essen- 

 tial with many patients with which stu- 

 dents can come into close contact. The 

 separate development in America of hos- 

 pitals and medical schools has retarded 

 clinical teaching. In this country ho.spitals 

 are usually municipal or privately-endowed 

 institutions under their own governing 

 boards. With rare exceptions do medical 

 schools exercise any influence in determin- 

 ing staff appointments in these hospitals. 

 In them seniority promotion is often the 

 rule and this in itself withdraws a very 

 strong stimulus for the best work and acts 

 to retard the development of members of 

 the hospital staff. Under these conditions 

 the medical school has but little choice in 

 its selection of professors and instructors 

 in clinical subjects. The man controls the 

 clinical material which the medical school 

 must have and so he becomes professor 

 whatever may be his qualifications for 

 teaching. Very generally in our hospitals 

 members of the staff are on duty but three 

 or four months of the year. This necessi- 

 tates multiplicity of teachers and prevents 

 continuity of instruction and investigation. 

 These are factors on the side of American 

 hospital organization which have acted to 

 retard clinical teaching and clinical inves- 

 tigation and which should be changed in 



