Page:Carnegie Flexner Report.djvu/113

Rh course in clinical microscopy will precede the period when the student is specifically charged with responsibility for the laboratory facts in his own “cases,” shortly to be described. Of equally essential importance to the rounding out of the medical curriculum is the autopsy-room, where the wise are brought to book. “Successful knowledge of the infinite variations of disease can only be obtained by a prolonged study of morbid anatomy. While of special value in training the physician in diagnosis, it also enables him to correct his mistakes, and if he reads its lessons aright, it may serve to keep him humble.

The teaching dispensary follows the same lines as the teaching hospital in respect to both organization and equipment, and must be constructed with its pedagogical use in view. It consists essentially of a commodious receiving-room, leading from which are separate rooms, sufficiently large, clean, well lighted, each assigned to a separate department. The several rooms are appropriately equipped with instruments, apparatus, etc., and with a recording system which enables the workers to keep track of each patient and to collate readily all cases of the same general character. Each department must have an organized teaching staff; the receiving-room must be in charge of a physician, who will assign patients to the departments to which they severally belong. The clinical laboratory must be at hand so that the necessary microscopical examinations can be made without loss of time.

From the teaching point of view, the hospital and the dispensary differ in certain respects; certain classes of cases do not usually enter the hospital wards at all: minor surgery, trivial medical ailments, numerous afflictions involving eye, ear, nose, throat, skin, etc. Ambulatory patients are also under less satisfactory control; a large proportion never come a second time. The dispensary is therefore excellently adapted to show a large variety of conditions; it is a relatively poor place to watch their development. In the dispensary the student can become expert in initial physical examination; but only the hospital wards enable him to study progress, to observe nature's comment on therapeutic moves. The dispensary corresponds to the "office hour," — so important an item in the physician's early progress; the hospital ward represents the sick-room. Clearly, a huge dispensary does not wholly offset a defective hospital.

Between dispensary and hospital, clinical instruction in the third and fourth years is variously apportioned. But apportioned they must be; for the mingling of third