Page:Carnegie Flexner Report.djvu/77

Rh short, research, untrammeled by near reference to practical ends, will go on in every properly organized medical school; its critical method will dominate all teaching whatsoever; but undergraduate instruction will be throughout explicitly conscious of its professional end and aim. In no other way can all the sciences belonging to the medical curriculum be thoroughly kneaded. An active apperceptive relation must be established and maintained between laboratory and clinical experience. Such a relation cannot be one-sided; it will not spontaneously set itself up in the last two years if it is deliberately suppressed in the first two. There is no cement like interest, no stimulus like the hint of a coming practical application.

Medical reference, in the sense that the laboratory sciences should, while freely presented, be kept conscious of their membership in the medical curriculum, has been discredited in this country, because it had so long meant a mechanical drill in an inert outline of the several sciences by untrained and busy practitioners. In the effort to teach the modicum of chemistry or physiology or pathology that "the family doctor needs to know," they neglected to teach anything of permanent scientific value at all. A revulsion was inevitable. It was supposed that the harm was due to the simple fact of medical reference. Such was not really the case. The sciences were badly taught, not merely because they were made prematurely and excessively conscious of medical application,—though such had indeed been the case,—but because the teachers lacked abundant scientific knowledge and spirit. Had they had these, the medical reference would neither have dominated nor impoverished their presentation. Our experience then furnishes a conclusive argument against delegating the teaching function to essentially unscientific practising physicians; it does not recommend the isolation of the laboratory sciences, locally or scientifically, from the clinical work. If it meant that, then institutions like the Johns Hopkins Medical School, in which laboratories and hospital are compactly organized from the standpoint of a scientific education in medicine, would labor under a positive disadvantage as compared with schools that, by reason of their situation, must in the scientific years forego the bedside and the autopsy altogether. In sober truth, four years are none too many thoroughly to saturate the student with medical enthusiasm and to give him the physician's standpoint; nor will laboratory and clinical ends make a genuine whole unless they have throughout a speaking acquaintance with each other.

Physiology and pathology belong, then, in the university, because there is much more to them as sciences than the medical school has time for. In so far, however, as they figure in medical education, they cannot be allowed to be indifferent to this definite function. "There must be an outlying division of workers who will keep the