692 



SCIENCE 



[N. S. Vol. XLIII. No. 1116 



been engaged with more or less activity in 

 the practise as well as in the teaching of 

 medicine, who has been associated with two 

 universities in which interesting experi- 

 ments in medical education are now in prog- 

 ress, these discussions have been of absorb- 

 ing interest. 



"With all the divergences of opinion and 

 amid all the heat of discussion the goal 

 aimed at is almost universally the same. It 

 is our desire that the hospital, the school of 

 medicine and the teaching staff shall be so 

 organized that the ultimate service to 

 humanity may be the largest ; that we may 

 gain greater knowledge of disease; that we 

 may acquire more efficient means, public 

 and private, of recognition, prevention and 

 alleviation of the innumerable ills to which 

 the human race and its inarticulate com- 

 panions and servants are heir : that we may 

 become more efficient in the care of our pa- 

 tients; that we may train better phj^sicians. 

 These are the main ends of the study of 

 medicine. It has seemed to me well to de- 

 vote this hour to a discussion of some of the 

 phases of the relations between practise and 

 teaching. 



In the early days, the study of medicine 

 in this country was begun in the office of 

 the practising physician. By and by there 

 developed schools of medicine in which the 

 teachers were successful practitioners. The 

 first of these schools were associated with 

 hospitals, and although the body of teach- 

 ers was not large, yet John Morgan in his 

 famous address on medical schools, early 

 pointed out the necessity that special 

 branches of medicine should be taught by 

 men who had given their greater attention 

 to these branches in practise. The pro- 

 fessors of medicine and of surgery who bore 

 the brunt of the teaching and directed their 

 departments were usually busy men much 

 sought for by the public in their commu- 

 nity ; and the teaching in the old days con- 



sisted largely of didactic lectures, with but 

 limited demonstrations. Only thirty years 

 ago, at the time when I was a student of 

 medicine, the duties of the professor of 

 theory and practise consisted solely in the 

 delivery of several didactic lectures a week ; 

 those of the professor of clinical medicine 

 consisted in the giving of two demonstrative 

 clinics and one clinical conference. An 

 assistant professor held one recitation a 

 week. An occasional ward visit was given 

 in one or another of the large hospitals, but 

 these opportunities were improved by but 

 a small proportion of the students. Phys- 

 ical diagnosis was taught during the second 

 year to a class of about ninety by three in- 

 structors in several hourly exercises a week 

 in sections of 20-30. This constituted the 

 work of the department of medicine. 



The direction of such a department was 

 properly confided to a distinguished prac- 

 titioner, a man of wide experience ; and its 

 management involved demands upon his 

 time no greater than were compatible with 

 the suitable performance of his hospital and 

 private duties. 



In such a school of medicine the clinical 

 instruction of a single medical department 

 or unit could be, and often was, carried out 

 in a variety of hospitals — those hospitals 

 with Avhich the professors of medicine had 

 the good fortune to be connected. The only 

 association between the university and the 

 hospitals was, in many instances, an amica- 

 ble agreement on the part of the latter to 

 allow instruction in the out-patient de- 

 partments, through public clinics in amphi- 

 theater and operating room, and to a cer- 

 tain limited extent in the wards. There 

 were no university laboratories connected 

 with the hospital. University laboratories 

 existed at another center which might or 

 might not be near, or at a considerable dis- 

 tance from the hospital. These laboratories 

 depended in large part upon the hospital 



