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SCIENCE 



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



however free a cooperation there may be 

 between the university and hospitals situ- 

 ated at a distance from the central plant, 

 one must acknowledge the necessity to a 

 modern medical school of one central hos- 

 pital. And so it has come about that any 

 discussion of the organization of a modern 

 medical clinic presupposes that which, for 

 purposes of illustration, may be called a 

 "university hospital" as its center, and 

 calls for a consideration of certain hospital 

 arrangements as an integral part of the 

 problem. Such a hospital should be organ- 

 ized upon a basis entirely different from 

 that which used to prevail and still exists in 

 many institutions. The medical clinic or 

 the surgical clinic, if it is to do its full duty 

 to the public, to the hospital and to the 

 school should be a well-organized unit under 

 the control of a single director and a corps 

 of associates and assistants. And of this 

 corps of associates and assistants, some at 

 least, preferably a considerable number, 

 should be salaried men, who are required to 

 give a large part of their time to their hos- 

 pital and university work. All of these 

 men should be members of the teaching 

 staff of the university. Only in a clinic 

 organized on some such permanent plan can 

 constructive research be carried out or sys- 

 tematic instruction given. The old-fash- 

 ioned rotating service is incompatible with 

 the ideals of a modern hospital or univer- 

 sity. 



According to the size of the institution 

 one or more such clinics may exist, and 

 there is no reason why in a large hospital 

 there might not be two or more separate 

 clinics, or why in a given university there 

 might not be several more or less independ- 

 ent professorships of medicine with clinics 

 at different hospitals, if the means were 

 forthcoming to supply the necessary mate- 

 rial for the full organization of such clinics. 



But to return again to the organization 



and constitution of a single department of 

 medicine as compared with that of thirty 

 years ago. The changes in the method of 

 teaching clinical medicine have been great. 

 Demonstrative clinical lectures remain an 

 important element of medical teaching. 

 But the place of the didactic lecture has 

 largely been taken by practical instruction 

 before small groups at the bedside. This 

 involves a considerable increase in the 

 teaching staff and increases greatly the 

 amount of time which the teacher must give 

 to his work. Thirty years ago the pro- 

 fessor of medicine may have been expected 

 to give two or three hours a week to his 

 classes. To-day he could hardly be expected 

 to devote less than six or eight hours to per- 

 sonal teaching. The problems of the teach- 

 ing of physical diagnosis in its restricted 

 sense are not so different from those of 

 thirty years ago ; but to-day it is generally 

 recognized that the university should offer 

 the student far more individual practical 

 training than he used to receive. In the old 

 days, three men, let us say, were entrusted 

 with the teaching of a class of ninety; to- 

 day the work would be distributed among 

 six or eight at least. 



Thirty years ago there was no such thing 

 as a clinical laboratory, and clinical micros- 

 copy and chemistry were not taught in the 

 medical department. Indeed, there were no 

 special medical laboratories. To-day a mod- 

 ern medical clinic must, in the first place, 

 control a clinical laboratory presided over 

 by men who are called upon to give a con- 

 siderable portion of their time to the train- 

 ing of the student in a large variety of 

 methods of examination of secreta, excreta 

 and body fluids ; and this laboratory should 

 also be a center for scientific research. 

 Thirty years ago, it was easy for one man to 

 preside over the entire department of medi- 

 cine and to conduct his practise as well. It 

 is extremely difficult, if not impossible, for 



