Page:Carnegie Flexner Report.djvu/137

Rh once subject the clinical end is distinctly apparent in the remote half of the divided school. We have already considered the perplexities of the laboratory end without contact with clinics. They appeared not insoluble. Whether two clinical years given by themselves with practising physicians as teachers can ever form a substantial texture is highly problematical. The latter half of a divided school is given by the University of California at San Francisco, by the University of Nebraska at Omaha, by the University of Kansas in a suburb of Kansas City, by Bowdoin College at Portland. The American Medical Missionary College carries division still further. It is divided between Battle Creek and Chicago; but no single year is entirely given in either place. Every class is shifted in the course of the year from one town to the other. Nor does the division end here; for at Chicago, the clinical instruction is divided so that different pieces are given at widely separated places. These pieces do not touch each other, and none of them ever touches the laboratory work given in Battle Creek. Indeed, none of the detached clinical departments is doing well. The vitality of the clinic depends on the closeness of its commerce with the laboratory branches; otherwise the clinical end is not rooted. Thus far none of these has achieved either executive or scientific intimacy. A certain degree of executive unity may perhaps be secured through a dean freely circulating between the two parts, though if he is attached as professor to one end of the department, the other is apt to resent intrusion. Scientific unity seems in any case unattainable. The clinical men at Omaha or San Francisco simply cannot be at home in the laboratories of Lincoln or Berkeley. Laboratories must be duplicated at the clinical site if the clinicians are to be in touch with them: in which case the divided type of school tends to turn into the whole remote type illustrated by the medical departments of the universities of Texas at Galveston, Indiana at Indianapolis, and of Cornell at New York. The truth is that an efficient medical school is a compact whole, in which geographic unity of laboratories and hospital is essential to scientific and educational integrity. The wilted condition of the clinical ends of the divided schools is a warning that Michigan, now contemplating the removal to Detroit of the final year in medicine, may well weigh. Even separation of the two parts within one city is a disadvantage. Division seems justifiable only as a temporary expedient to get clinical material, pending a choice between concentration of the entire school at one point or the other, or outright abandonment of clinical instruction in favor of a two-year school."