to transport thither many cases from other parts of the state. The outcome practically formulates for us the terms upon which such an enterprise is feasible: a modern equipment, a salaried clinical faculty, clean-cut ideals, and careful husbandry will build up a substantial clinic in a small American as in a small German town. It can be supplemented by bringing the hospitals of the entire state into working relation with the medical department of the state university. The expense of the establishment is relatively great; but the advantages over a divided, perhaps even a remote department,[1] are on the whole cheap at the price. How many more such institutions we should, however, now undertake to create is of course quite another question.[2]
The Johns Hopkins Medical School has been even more highly favored. Its hospital endowment was, fortunately, sufficient to warrant a comprehensive design from the start. The general teaching hospital then provided has been recently supplemented by generous benefactions that add separate clinics for tuberculosis, pediatrics, and psychiatry; wards, dispensary, clinical and scientific laboratories, coöperate for both pedagogic and philanthropic purposes. The clinical departments are organized like any other. Nowhere else in the country has so consistent a scheme been so admirably realized. The student is made a factor in the conduct of the hospital : he assists on the clinical side as clerk, on the surgical side as dresser, following the admirable method long in vogue in the Scotch and English schools. In each department he serves an appointed novitiate, following his "cases" from start to finish,—now to recovery, again to autopsy
There is no insuperable reason why several other medical schools should not take advantage of a fortunate relation to hospitals to bring about an equally effective organization. In one place lack of money, in another, hampering tradition, alone prevents. The organization above described cannot be perfected unless these two defects are simultaneously cured. If hospitals are to enter into exclusive and practically complete relationship with a single medical school, the university must on its side procure funds which enable it to be independent of the local profession. Unle these two conditions are coincidently fulfilled, the clinical situation cannot be thoroughly made over. Three Philadelphia schools (the University of Pennsylvania, the Jefferson Medical College, and the Medico-Chirurgieal College), two Baltimore schools (the University of Maryland and the College of Physicians and Surgeons), and one Chicago school (Rush Medical College),[3] are in sole and complete control of excellent hospitals, more or less adequate in size. The same intimacy is equally desirable and equally feasible for both parties in interest between Wesley Hospital and North-
- ↑ The divided department is discussed from the laboratory side, page 74; from the clinical side, page 119. For an account of remote departments, see (Part II) University of Texas, University of Indiana, Cornell University.
- ↑ Similar hospitals, not as yet so well developed, are at present connected with several other state universities: the Universities of Iowa, Colorado, Minnesota, Texas. The details are given in Part II, under the several institutions.
- ↑ But in this instance the patient's consent must first be obtained.
