Medicine – The Hospital As a College Part 3

A third change is in reorganization of the medical school. This has been accomplished in the first two years by an extraordinary increase in the laboratory work, which has necessitated an increase in the teaching force, and indeed an entirely new conception of how such subjects as physiology, pharmacology and pathology should be taught. A corresponding reformation is needed in the third and fourth years. Control of ample clinical facilities is as essential today as large, well-endowed laboratories, and the absence of this causes the clinical to lag behind the scientific education. Speaking for the Department of Medicine, I should say that three or four well-equipped medical clinics of fifty to seventy-five beds each, with out-patient departments under the control of the directors, are required for a school of maximum size, say 800 students. Within the next quarter of a century the larger universities of this country will have their own hospitals in which the problems of nature known as disease will be studied as thoroughly as are those of geology or Sanscrit. But even with present conditions much may be done. There are hundreds of earnest students, thousands of patients, and scores of well-equipped young men willing and anxious to do practical teaching. Too often, as you know full well, “the hungry sheep look up and are not fed;” for the bread of the wards they are given the stones of the lecture-room and amphitheatre. The dissociation of student and patient is a legacy of the pernicious system of theoretical teaching from which we have escaped in the first and second years.

For the third and fourth year students, the hospital is the college; for the juniors, the outpatient department and the clinics; for the seniors, the wards. They should be in the hospital as part of its equipment, as an essential part, without which the work cannot be of the best. They should be in it as the place in which alone they can learn the elements of their art and the lessons which will be of service to them when in practice for themselves. The hospital with students in its dispensaries and wards doubles its usefulness in a community. The stimulus of their presence neutralizes that clinical apathy certain, sooner or later, to beset the man who makes lonely “rounds” with his house-physician. Better work is done for the profession and for the public; the practical education of young men, who carry with them to all parts of the country good methods, extends enormously the work of an institution, and the profession is recruited by men who have been taught to think and to observe for themselves, and who become independent practitioners of the new school of scientific medicine—men whose faith in the possibilities of their art has been strengthened, not weakened, by a knowledge of its limitations. It is no new method which I advocate, but the old method of Boerhaave, of the elder Rutherford of the Edinburgh school, of the older men of this city, and of Boston and of Philadelphia—the men who had been pupils of John Hunter and of Rutherford and of Saunders. It makes of the hospital a college in which, as clinical clerks and surgical dressers, the students slowly learn for themselves, under skilled direction, the phenomena of disease. It is the true method, because it is the natural one, the only one by which a physician grows in clinical wisdom after he begins practice for himself—all others are bastard substitutes.