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Rh adding schools with hospitals not as yet adequate in size, of which type the University of Virginia furnishes the most satisfactory example. Long contentedly a didactic school, this institution has just undertaken to develop a modern clinical department. The new and excellent University Hospital, with eighty ward beds, is still under size. But a speedy development may be somewhat confidently anticipated. Its problem is that which Michigan has already shown how to solve; meanwhile it is perfectly clear that the justification of such a school lies in the fact that its situation makes possible the most intimate relations between the clinic and the scientific laboratories, and a discipline in medical technique so thorough and so vigorous that a few gaps in the student's experience may prove relatively insignificant. There is every indication that the University of Virginia thoroughly appreciates both points.

By no means every hospital owned by a medical school is, however, to be reckoned a teaching asset. The details require to be closely scanned. In many cases they are private institutions, in process of being paid for out of their own profits and out of the fees of medical students, who are lured by the advertisement of a school hospital from which they get no good at all. Barnes Medical College (St. Louis) adjoins Centenary Hospital, "which affords clinical facilities surpassed by none and equalled by few;" but except for part of one floor, the building is given over to private rooms.

Where control ceases, ideals necessarily change. A medical school with its own hospital may of course be sterile. Unwise appointments may cut off all possibility of productivity; too much consultant prosperity may be fatal to scientific zeal; inbreeding may exhaust fecundity. On the other hand, an occasional clinician may keep his lamp trimmed despite every obstacle,—poor facilities, a precarious term of service, lack of appreciative sympathy. Neither the one nor the other contingency, however, militates against the position that as between the two systems a school hospital is in America essential to the existence of an efficient department of clinical medicine; that in its absence the general plane of instruction settles down to a distinctly lower level.

The best of the schools without a hospital which they can call their own do not lack for abundance or variety of clinical material. Rush, Northwestern, the College of Physicians and Surgeons (Chicago), Columbia, Cornell, and the University and Bellevue Hospital Medical College (New York), Harvard and Tufts (Boston), are not troubled for clinical material; some of them have more of it than they can possibly use,—much more than several of the university hospitals can ever hope to command. But the conditions to which they submit in order to gain access to it at all, though varying somewhat from place to place, are alike fatal to freedom and continuity of pedagogic policy. Our clinical failure concurs with the clinical success of the Germans in proving that freedom is the very life-breath of scientific progress,—freedom on