gical patients, and teachers "shall not conduct bedside clinics when possible to remove patients from the ward;"[1] on these terms 100 beds are available, for six hours weekly in surgery, and perhaps for a few more in medicine. At Creighton, students "witness the operation," and are admitted to about 90 beds. In Denver, students "are not much at the bedside; they just look on;" the hours are from 8.30 to 10 a.m., daily,— the early hour having been fixed, it is alleged, to prevent the attendance of the state university boys at Boulder. There are "ward classes" at Memphis—as many as fifty students in a group at once!
Where things are patched up in the way described, it is of course impossible that proportions and relations should be observed. We have urged that the backbone of clinical training must be internal medicine. But it is preeisely here that the schools are in general weakest. The sum total of accessible beds may amount to a hundred: not infrequently less than one-fifth of them will contain medical cases. The "additional facilities" of the larger schools are mainly surgical in character; and in general, the less a school has to offer in the way of clinical facilities, the more heavily is surgery overweighted. Its pedagogical value is relatively slight; for operations are performed in large amphitheaters in which the surgeon and his assistants surround the patient, to whom they give their whole mind, in practical disregard of the students, who loll in their seats without an inkling of what is happening below. Most of the students see only the patient's feet and the surgeon's head. Only in rare cases, previously mentioned, in which the student helps to form the machine, do designated individuals take turns and become part of the operation,—making the examination, watching the procedure at close range, and "cleaning up" afterwards. Inadequacy in general is thus aggravated by increasing predominance of surgical over medical clinics. Clinical teaching thus tends more and more to concentrate in the amphitheater. The laboratory side sinks further and further into the background; the bedside work becomes more and more contracted. The whole thing is demonstrative—and at steadily increasing remoteness. At the University of Vermont juniors and seniors have most of their medical and surgical clinics together, averaging in medicine about three hours weeklynne year and four hours weekly the next; and the work is mostly in the amphitheater. Dartmouth Medical School has access to 24 beds, eighty per cent of the patients occupying which are surgical cases. Bowdoin—to complete the list of the smaller New England schools—uses the Maine General Hospital, Portland, where surgery greatly predominates. Tufts has an imposing array of clinical facilities but its medical clinic is limited to the Boston Dispensary and one service in the City Hospital. Kansas Medical College relies almost wholly on three hospitals, in which it gets a total of nine or ten hours' instruction weekly: in two of the three hospitals all the work is surgery; in the remaining, two-thirds of it. in the university hospital at Rosedale (University of Kansas), there were last year 240 patients, 190 of them surgical; six free beds are this year reserved for
- ↑ Rules and Regulations, Los Angeles County Hospital, section 4, rule 12.
