698 



SCIENCE 



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



A distinguished student of the problems 

 of medical education has been quoted as 

 saying essentially: "Diseases are the same 

 in the rich and in the poor, in human beings 

 and in animals. To the clinician the ward 

 is his laboratory, and the study of disease 

 in the patient in the ward is, in all essen- 

 tials, the same as the study of disease 

 in the animal in a laboratory. The only 

 difference between the study of disease in 

 hospital and outside is that in the hospital 

 the patient may better be observed. It is a 

 mistake to say that it is necessary for a pro- 

 fessor of medicine to have had experience 

 in private practise when the same experi- 

 ence may be obtained more intelligently and 

 in a much more concentrated form in the 

 hospital. ' ' 



This conception which has, by some, been 

 regarded as characteristic of the point of 

 view of those who have favored the estab- 

 lishment of professorships of medicine on 

 the so-called "full time" basis, has been 

 looked upon as fallacious and dangerous by 

 many of the opponents of certain modern 

 tendencies in medical education. 



"No man," they say, "is fit to teach 

 students the art of the practise of medicine 

 who has not himself passed through the ex- 

 pepences of the practitioner. Practise in 

 a hospital ward is one thing ; practise in the 

 home of the patient, another. He who has 

 been accustomed to rely on the trained 

 nurse and on the many appliances and in- 

 struments of precision which a well- 

 appointed hospital affords, can have little 

 conception of the difficulties which he will 

 encounter in private practise. He whose 

 only experience has been with the trusting, 

 unresisting patient in the general wards, 

 will find himself at sea when treating the 

 whimsical, critical, prejudiced, opinionated 

 invalid in private life. He who has been 

 accustomed largely to study serious dis- 

 eases in the wards of the hospital will have 



small sympathy with, and little understand- 

 ing of the trivial complaints of the super- 

 sensitive and nervous members of the more 

 well-to-do classes. The conditions that he is 

 called upon to treat are to be remedied in 

 great part by minor regulations of habits 

 and manner of life, of eating and drinking 

 and smoking and exercise. His main duties 

 consist in ministering to the minds of his 

 patients — in kindly counsel and encourage- 

 ment — in advice tending toward the allevia- 

 tion of a thousand petty ills which he who 

 knows that they will pass with time, does 

 not even consider in himself — which the 

 less sensitive patient in the ward barely 

 notices. How can one who has never had 

 this experience teach students the art of 

 practise? Is it not folly to take away the 

 teaching of medicine from the experienced 

 practitioner and to give it to one who has 

 had a training which might almost be called 

 academic ? Must we not regard this idea as 

 the dream of the layman and of the labo- 

 ratory student who, with aU his scientific 

 attainments, is yet wofuUy ignorant of the 

 conditions of the doctor's life and of his 

 duties?" 



There is much truth in these objections. 

 I should have no hesitation in agreeing that 

 the medical experience suitable to qualify a 

 physician as a consultant or a teacher of 

 medicine can not well be obtained wholly 

 in the free wards of a hospital. There is a 

 great difference between the mental work- 

 ings of the patient in the free ward and 

 those of the average individual with whom 

 one is thrown in private practise. The 

 stolid indifference to outside influences 

 shown by many patients in the general 

 wards renders the study of disease in hos- 

 pital not so very different, it is true, from 

 the study of disease in the laboratory, but 

 so soon as one becomes associated with pa- 

 tients of a higher mental order, problems in 

 diagnosis and in treatment arise which are 



