lations in so far, at least, as they determine (1) continuity of service on the part of the teachers of medicine, (2) the closeness with which the student may follow the progress of individual patients, and (3) the access of the student to the clinical laboratory. It matters much less what else a school has by way of clinical opportunity if it has this, though, of course, the school that has it will have whatever else it needs too. The main point is that there is no substitute for a good clinic in internal medicine; the school sampled and found wanting there suffers from a fatal organic lesion. Excellent didactic instruction is no compensation; successful passing of written state board or other examinations is no proof that the school has managed to do without. A large surgical service with amphitheater operations every day in the week, a dispensary crowded with eye, ear, and throat cases,—these are all very well in their way. But one comes back to the medical clinic: that is the really important item. Until practical state board examinations can be trusted to disclose defective school facilities on the clinical side, it is thrice important to scrutinize carefully the situation of every medical school in this respect. For proper provision rests at this moment on the conscientiousness and intelligence of medical educators. Thus far the states have not adopted an examination procedure that will destroy schools not able to do their duty in regard to the medical clinic.
The student's clinical work is classified under four heads: (1) medicine, in which pediatrics and infectious diseases may be included, (2) surgery, (3) obstetrics, (4) the specialties, such as diseases of the eye, ear, skin, etc. A teaching hospital consists essentially of a series of wards, accommodating patients belonging to these several departments, each ward systematically organized with a permanent staff; of a clinical laboratory, similarly organized and in close organic relation with the wards; and of an autopsy-room. The clinical laboratory of the hospital is not the same as the pathological laboratory of the medical school. "A clinic of medicine needs a laboratory equipped with apparatus for chemical, physiological, pathological, and bacteriological work, not so completely equipped as is the laboratory of these respective departments in the medical school, but specially equipped for certain needs of the work."[1] On the value of the data thus obtainable it is unnecessary longer to dwell. The clinical laboratory is the connecting link between the two parts of the medical school; and it must be immediately accessible. The clinical teacher cannot stop for data that he must perhaps cross town to get; the student responsible for a particular case will not include in the facts on the basis of which he is making up his mind the results of an examination of blood, sputum, and feces, if these must be transported for study much beyond the hospital walls. Nor will the interne or the young practitioner require the knowledge in question before coming to a conclusion, unless he has formed at school the habit of so doing.[2]In this laboratory a theoreti-
- ↑ Henry A. Christian: "The Clinical Laboratory," in Columbia University Quarterly, vol. xi., no. 3, p. 339.
- ↑ "We see the necessity of laboratories with room for each clinical student, each with his work-place properly equipped. In building this well arranged laboratory the university has by no means erected something superfluous. ... It has simply met a positive need. In putting the laboratories in such intimate relations with the hospital, and especially with the dispensaries, it has provided means for an immense increase of its facilities. It is a place for practice, for doing as an undergraduate the things that must be done afterward in carrying on the profession of medicine." George Dock, "Address at Opening of Clinical Laboratory of the University of Pennsylvania Hospital," University of Pennsylvania Medical Bulletin, Aug., 1909 (slightly abridged).
