954 
laboratory years are no longer to be di- 
vorced from the clinical teaching of the 
later years of the curriculum. It means 
that men are to be trained by the ‘‘do it 
yourself’’ method to become practitioners 
with power of accurate diagnosis and the 
“‘mind which is prepared’’ to take advan- 
tage of every ‘‘chance’’ observation and 
opportunity. It means that the newer 
methods of biological, physical and chem- 
ical diagnosis, evolved through laboratory 
effort, are to work a transformation in 
medical teaching and medical practise 
analogous to that which came in the middle 
of the past century through the introduc- 
tion of exact methods of physical examina- 
tion. As physical diagnosis raised medi- 
cine above the plane of objective diagnosis 
and revealed the morphological changes 
in diseased organs of the interior of the 
body, so now the methods of physiological 
chemistry and immunology are destined 
to reveal the changes in the eells and 
fluids of the body which are dependent on 
intoxication, infection and altered meta- 
bolism and thus bring about an advance 
in methods of diagnosis, the fruits of which 
are almost beyond our powers of imagina- 
tion. 5 
Herein lies the most potent argument 
for close affiliation of school and hospital. 
The task, both from the teaching side and 
from the research side, demands united ef- 
fort, common use of material and common 
financial responsibility. While any con- 
tract between university and hospital must 
leave the general support of the hospital 
in the hands of the hospital management, 
the school must be prepared to pay the sal- 
aries of attending staff, the cost of equip- 
ment and the expenses necessary for teach- 
ing and research and to assume the respon- 
sibility for the medical and surgical care 
of the patients and the general conduct of 
the scientific work. On the other hand, the 
SCIENCE 
[N.S. Vou. XXXV. No, 912 
hospital should leave the matter of ap- 
pointments, subject to its nominal ap- 
proval, entirely in the hands of the school, 
with the understanding that withdrawal or 
resignation from the school automatically 
would sever connection with the hospital, 
and vice versa. Such an arrangement 
settles most of the problems of medical 
education. Continuous service and free- 
dom in the appointment of clinical teach- 
ers come as a matter of course. Teaching 
and investigation can be carried on with- 
out interruption. The student becomes a 
part of the hospital routine and is not an 
onlooker with limited privileges. The lab- 
oratory departments of the first and sec- 
ond years unite to aid the work of the 
clinicians in the hospital. Clinical teach- 
ers may be promoted, if deserving, or may 
be called from any part of the country, or 
from abroad; the choice no longer depends 
on local hospital appointments or on the 
selfish interests and friendships of local 
consultants, but on fitness, eminence and 
skill. 
Teachers may be appointed on a uni- 
versity basis, devoting all or most of their 
time to the eare of the patients, to teaching 
and to investigation. The heads of the de- 
partments of internal medicine and sur- 
gery certainly should be so appointed. 
Under such circumstances these men with 
their staffs could control a large body of 
students working relatively independently 
among the patients in the wards and in the 
special laboratories in or near the wards. 
In these clinical laboratories every student 
should have his own desk and outfit for 
microscopic, chemical and other methods 
of examination. Not merely apparatus for 
the simpler tests should be supphed, but 
as well every facility for prolonged bac- 
teriologic examination, animal inoculation 
and detailed chemical and physiologic 
study. 
