152 



SCIENCE 



[Vol. LVI, No. 1441 



eieneies of their own brancli of the work. To 

 make up these deficiencies of preventive medi- 

 cine we must continue to develop the curative 

 side, but beside the technique of curative med- 

 icine our students must now have also a train- 

 ing that shall enable them to continue to de- 

 velop with the growth of medical knowledge 

 and this, the greatest asset of an education, 

 demands educational institutions that are 

 themselves the sources of such growth. 



It is frequently said by those who oppose 

 the full-time scheme, that workers in labora- 

 tories do not possess technical clinical skill. 

 It is true; moreover, those who are to teach on 

 the clinical side must have clinical skill, their 

 work must be with patients. But for those 

 who are to be our clinical teachers the con- 

 trast is not between the laboratory and the 

 clinic but between private practice as against 

 practice with patients in hospitals. From the 

 standpoint of acquiring skill and experience 

 for the doctor, it seems to me that there can 

 be no question but that the advantage lies in 

 having patients in hospitals. To illustrate. 

 Osier's well-known text-book of medicine was 

 written as a record of his experience and that 

 of his colleagues in dealing with the sick in 

 the Johns Hopkins Hospital. One might make 

 it still stronger and say that it is only in hos- 

 pitals that studies and records of clinical ma- 

 terial adequate enough to make any large con- 

 tribution to clinical medicine can be made. 

 Indeed, to go iback historically, the early 

 studies on tuberculosis of the great French 

 physician, Louis, were made from records of 

 patients in a hospital and started the idea 

 that the hospital is the laboratory of clinical 

 material. Indeed, at the present time many of 

 the exceptionally successful physicians in pri- 

 vate practice are developing hospitals of their 

 own of which the Mayo clinic is a conspicuous 

 example. For surgery, practically all of the 

 work has already been transferred to hospi- 

 tals, and for medical practice, the advantages 

 to the patient are producing the same change. 

 Thus, even if it be admitted, and it can not 

 be doubted, that for the study of disease the 

 hospital has every advantage over the home, 

 still the opponents of the full-time scheme 

 have often claimed that on the side of making 



human contacts, of learning how to deal vnth 

 people, the private practitioner has a kind of 

 experience that a teacher and a physician who 

 deals only with patients in hospitals never 

 acquires — I deny it. The school and hospital 

 are as much a part of the world as the sick 

 man in his home. The same ability to have 

 really great influence in dealing with people 

 makes toward success in a hospital or in a 

 class room as in a private practice. There are 

 two facts, however, which we should recog- 

 nize, if we want to see all sides of the ques- 

 tion. First, the teacher is somewhat artificially 

 protected from the consequences of poor work. 

 The teacher is always dealing with minds that 

 are immature in his particular subject; and 

 in the organization of our educational system 

 the criticisms of students, that is, of those 

 who are most affected by inefficient teaching, 

 are allowed but little weight. I understand 

 that in England students are not so docile as 

 with us. Moreover, the very low salaries paid 

 to teachers have led institutions to offer secur- 

 ity of tenure as a compensation. We should 

 recognize this, our institutions should set an 

 adequate value upon the profession of teach- 

 ing, and should demand high standards of 

 work. Secondly, hospitals develop a routine 

 in which the feelings of people are forgotten. 

 If many of our hospitals had more of the 

 spirit of exceedingly efficient service that char- 

 acterizes our best hotels, there would be less 

 room for legitimate criticism of caring for the 

 sick in institutions. I do not think that this 

 criticism applies so much to the smaller hos- 

 pitals, but in some of the larger ones, where 

 the actual medical work is done exceedingly 

 well, the management of the institution could 

 learn much from efficient business. 



Thus we are quite willing to admit the defi- 

 ciencies of our present educational system; we 

 believe that it should be subjected to criticism, 

 for it is better that its faults should be known 

 than concealed. We recognize all the advan- 

 tages of curative medicine, and that our pres- 

 ent skill in dealing with disease represents a 

 great achievement; nevertheless, we believe that 

 the whole of medical education should be in 

 the hands of professional educators who will 

 recognize that the still more brilliant achieve- 



