says Dr. Keen, "as a surgeon to a half-dozen hospitals, and can confidently say that I have never known a single patient injured or his chances of recovery lessened by such teaching. Moreover, ... who will be least slovenly and careless in his duties, - he who prescribes in the solitude of the sick-chamber and operates with two or three assistants only, or he whose every movement is eagerly watched by hundreds of eyes, alert to detect every false step? ... I always feel at the Jefferson Hospital as if I were on the run, with a pack of lively dogs at my heels."[1] Miss Banfield, after an ample experience, looking at the question solely from the standpoint of patient and nurse, takes the same position: "As a matter of fact, in a properly administered hospital, medical schools are a protection to the patient rather than otherwise, for it usually means that the hospital is a very live one. ... In teaching hospitals, I think that on the whole patients are generally better nursed, for every one is kept up to the mark, including the professors."[2] The committee appointed in 1905 to inquire into the financial relations between the hospitals and the medical schools of London, touch in their conclusions the point here in question: "We find," they say, "that the presence of a body of eager young men watching the proceedings of their teacher has the tendency to keep the medical man on the alert and to counteract the effects of the daily routine of duties."[3]
There is little difference of opinion as to the necessary size of a teaching hospital. Less than two or three hundred beds, in practically continuous occupation, can hardly supply either the number or the variety of cases required. It is held that a hospital of 400 beds will support a medical school of at least 500 students. It is highly important that the instructor should have the material that he needs when he needs it. The material must, moreover, be properly distributed: an abundant clinic in diseases of the eye is no substitute for defects in the departments of internal medicine and obstetrics; seventy-five cases of operated appendicitis do nothing to compensate for the lack of typhoid, pneumonia, or scarlet fever.
The size of the school has, of course, some bearing on the necessary size of the hospital, though the hospital cannot be allowed to shrink in exactly the same ratio as the number of students. Because two hundred beds may be made to suffice for one hundred students, it does not follow that twenty beds suffice for ten students. Twentyfive students require in general the same minimum as one hundred students. On the other hand, it is fair to weigh advantages and disadvantages against each other. A small number of students in a small but still fairly representative and completely controlled university hospital, through whose corridors fresh scientific breezes from the university and medical school laboratories blow, will get a better discipline in the
- ↑ W. W. Keen: "The Duties and Responsibilities of the Trustees of Public Medical Institutions," Transactions Congress Amer. Physicians and Surgeons, 1903.
- ↑ Maud Banfield: "Some Unsettled Questions in Hospital Administration in the United States," Publications of Amer. Acad. Pol. and Soc. Science, no. 351, pp. 46, 47 (slightly abridged).
- ↑ Report of the Committee. Published for King Edward's Hospital Fund for London, by George Barber, 23 Furnival Street, Holborn, E. C. p. v, 15 (B).
