apolis, students have no access, though in these hospitals, rich in material, the students of St. Louis University, Rush and the College of Physicians and Surgeons (Chicago), the University of Minnesota, respectively, ought to be getting the best part of their clinical training. Not infrequently it is alleged that the students do "carry material for examination back to the college:" the students of the Creighton School (Omaha) and of the Los Angeles schools would thus have to transfer specimens of urine, feces, and gastric contents on the street cars across town,--distances of several miles. At Southwestern University (Dallas, Texas), a section of four students has an assigned patient at the City Hospital, perhaps a mile and a half distant, where there is no clinical laboratory; to work up material, they must carry it to the college building, - where there is no clinical laboratory, either. Educationally, an "academic" laboratory discipline that thus hangs loose, that cannot be brought to bear on specific clinical cases, must be largely wasted. There is no merit in making a blood-count unless the student has been disciplined to connect the blood-count with all other symptoms of the patient whose blood is counted. As it is, he beholds a patient, sees things pointed out, may even listen to his heart-beat; away off in the college laboratory, he has previously examined some one's urine, counted some one's blood, tested, perhaps, an artificially prepared gastric juice. But there is no connection; the discipline splits in the middle. Scientific habits of practice are not established in that way. Nor are loose habits, thus contracted, cured by an interneship. Pupils are more apt to disappoint than to astonish their teachers; they do not generally better their instruction. In consequence hospital records made by internes graduated by these schools are scant and unsystematic. Defective methods at the University of Buffalo were extenuated on the plea that as internes they learn better; but the meager records of the Buffalo General Hospital disprove the claim. Whoever is responsible, poorly kept records are very apt to denote inferior bedside instruction. The situation is this: there lies the patient; teacher, interne, and students surround the bed. The case is up for discussion. A question arises that requires for its settlement now a detail of the patient's previous history, now a point covered by the original physical examination, now something brought out by microscopic examination at some time in the course of the disease. If complete, accurate, and systematic records hang at the bedside, there is an inducement to ask questions; doubtful matters can be cleared up as fast as they are suggested. That, then, is the place for the records,—full records, at that. In few instances are the records full; in still fewer are they, full or meager, in easy reach. At the University of Kansas, at Lane Hospital (Cooper Medical College, San Francisco), there is no uniform method of making or keeping records : "some men do better than others;" "it depends on the man." At the Protestant Hospital, Columbus, Starling-Ohio graduates are internes, the records are nurses' charts; at Trinity Hospital (Milwaukee), attached to the Milwaukee Medical College, the same is true.[1]
- ↑ Similar instances can be cited from all other sections of the country; the records are nurses' chart at the hospital of the College of Physicians and Surgeons, Little Rock, and at the City Hospital—used by two schools—at Memphis; at Ensworth Hospital, one line in a ledger contains all the facts on record; at Topeka, the same is true; it is added that "laboratory reports are not kept, and physical examinations could not be found;" the histories, made up by internes at the Kansas City Hospital, are so irregular that "the visiting staff don't even read them." They are imperfect at the University of Texas (Galveston); defective and careless at the Maine General Hospital (Portland).
