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The Current Era 
 
 O F T H E 
 
 Faculty of Medicine 
 
 Columbia University 
 
 1910-195-8 
 
 .^°^\ 
 
 WILLARD C. RAPPLEYE, M.D. 
 
 Dean of the Faculty of Medicine 
 and Vice-President in Charge of Medical Affairs 
 
 COLUMBIA UNIVERSITY • NEW YORK • 195! 
 

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Contents 
 
 FOREWORD 5 
 
 THE BACKGROUND 9 
 
 THE MEDICAL CENTER TAKES SHAPE 14 
 
 THE CONCEPT OF THE MEDICAL CENTER 17 
 
 THE EDUCATIONAL PROGRAM 23 
 
 THE DEPRESSION PERIOD 27 
 
 THE POST-DEPRESSION YEARS 3 1 
 
 THE MOMENTUM RESUMED 34 
 
 THE SECOND WORLD WAR 4° 
 
 THE REVIEW OF 1944 44 
 
 THE POSTWAR PERIOD 49 
 
 CONTINUING SELF-APPRAISAL 56 
 
 THE FUTURE OF THE MEDICAL CENTER 63 
 
 THE MEDICAL CENTER AT MID-CENTURY 67 
 
 THE TWENTY-FIFTH ANNIVERSARY 
 
 OF THE MEDICAL CENTER 75 
 
 NEW CHALLENGES 79 
 
 THE REPORT ON THE EDUCATIONAL 
 
 FUTURE OF THE UNIVERSITY 94 
 
 THE NEW HORIZONS 104 
 
Contents 
 
 APPENDICES 
 
 A. Letter from Mr. Edward S. Harkness 
 
 to Mr. Robert W. de Forest (19 10) 119 
 
 B. Agreement between Presbyterian Hospital and Trustees 
 
 of Columbia College (191 1) 122 
 
 C. Excerpts from "Memorandum on the Ideal Development of 
 Hospital and Medical School," by Dr. Samuel W. Lambert (1912) 128 
 
 D. Memorandum on the School of Medicine 
 
 by Dr. William Darrach (19 19) 130 
 
 E. Agreement between the Trustees of Columbia University 
 
 and Presbyterian Hospital (1921 and 1934) 138 
 
 F. Agreement between the Trustees of Columbia University, 
 Presbyterian Hospital and the City of New York (1936) 141 
 
 G. Agreement between Presbyterian Hospital, Columbia University 
 
 and the City of New York (1941) 146 
 
 H. Agreement between Trustees of Columbia University 
 
 and St, Luke's Hospital (1947) 149 
 
 I. Agreement between Trustees of Columbia University 
 
 and the City of New York (1954) 151 
 
 J. Agreement between Trustees of Columbia University 
 
 and Presbyterian Hospital (1955) 154 
 
 K. Agreement between Trustees of Columbia University 
 
 and Presbyterian Hospital (1956) 157 
 
 L. Administrative Officers of the Faculty of Medicine 161 
 
Foreword 
 
 The following is a brief resume of some of the recent activities of the 
 Faculty of Medicine, with particular reference to the period since the 
 founding of the Columbia-Presbyterian Medical Center. Many of the 
 plans and decisions were in response to the rapidly shifting socioeconomic 
 and professional conditions and the phenomenal growth of scientific 
 knowledge in this productive era of American medicine. A discussion of 
 some of these features which bear importantly upon the educational, re- 
 search, and financial activities of the school is included. This summary is 
 intended primarily for the information of the present staff and to pro- 
 vide a short history of the University's contemporary program of educa- 
 tion, research, and hospital services. 
 
 WlLLARD C. RAPPLEYE, M.D. 
 Dean of the Faculty of Medicine and 
 Vice-President in Charge of Medical Affairs 
 
 June 30, 1958 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/currenteraoffacu01rapp 
 
The Current Era 
 
 O F TH E 
 
 Faculty of Medicine 
 1910-195-8 
 
The Background 
 
 The current era of the Faculty of Medicine began to take concrete form 
 in 191 o, at which time the affiliation between the University and Pres- 
 byterian Hospital was formulated. There was a long history of earlier dis- 
 cussions of the needs and opportunities to which a few brief references 
 may be made because the present program had its roots deeply in the 
 evolution of American medicine and medical education. 
 
 From the inception of the Medical Faculty of King's College in 1767, 
 it was apparent that the Medical School required clinical facilities. Dr. 
 Samuel Bard, professor of the practice of medicine in King's College, in 
 the Commencement address on May 16, 1769, urged the establishment 
 of a general hospital in close relationship with the Medical School in 
 order to provide bedside instruction of pupils in the practice of medicine. 
 This was accomplished through the establishment of the New York Hos- 
 pital in 1 77 1, in which students of King's College Medical School received 
 instruction. 
 
 The early association of the school with the Medical Society of the 
 County of New York, organized in March, 1807, emphasized at that 
 period the close liaison and cooperation between the school and the 
 practicing profession, a situation which has continued up to the present 
 time. It was that society that organized the independent College of 
 Physicians and Surgeons in 1807. Professor Bard became president in 
 1811. 
 
 Limited clinical facilities were provided by the University in 1886 
 through the building of the Sloane Hospital for Women and the Vander- 
 bilt Clinic, both of which were under the administration of the school. 
 This provided hospital and clinic facilities under the supervision of the 
 University. President Seth Low of Columbia College emphasized in 1894 
 that medical education would be immeasurably improved if the school 
 could obtain control of a hospital for general medical and surgical di- 
 seases. 
 
 In 1903 President Nicholas Murray Butler advocated the early estab- 
 
io The Background 
 
 lishment of a general hospital under University auspices. Teaching was 
 conducted at Roosevelt Hospital after the College of Physicians and Sur- 
 geons moved to the Fifty-Ninth Street site. Medical students were 
 taught clinical subjects, but it was long felt that greater responsibility 
 for the actual instruction in the hospital would have to be exercised by 
 the Medical School. 
 
 During this period there were important developments in the over-all 
 situation relative to medical education in this country which were being 
 reflected in the program of Columbia University. The Association of 
 American Medical Colleges was organized in 1891 to coordinate the edu- 
 cational efforts of the leading medical schools. In response to the rapidly 
 growing scientific content of medical education, Harvard University in 
 1 892 increased the length of the medical course to four years. A number 
 of other schools promptly adopted similar programs. The founding of the 
 medical school of Johns Hopkins University in 1893 further stimulated 
 the national awakening in medical education. In 1899 the graded cur- 
 riculum for professional instruction was adopted widely throughout the 
 country. 
 
 Just previous to 1900 the American Medical Association had begun its 
 important work of collecting statistics on the medical schools. The grow- 
 ing recognition in this country of the value of University-directed med- 
 ical education was outlined forcibly in 1902 by Dr. Lewellys F. Barker, 
 then at the University of Chicago. In 1904 the American Medical Associ- 
 ation created the Council on Medical Education. In 1907 the Council is- 
 sued its first classifications of medical schools. In 1909 it adopted as its 
 standard the four-year course which was in force in most of the leading 
 schools. Seventeen schools had already established the requirement of 
 two or more years of college preparation for admission. Eleven more 
 made this regulation effective in 19 10. The requirement was embodied 
 in the minimum standards of the Council eight years later. 
 
 The monumental study of Abraham Flexner for the Carnegie Founda- 
 tion for the Advancement of Teaching was published in 1910. That re- 
 port and the publicity it received gave great impetus to the establish- 
 ment of high standards of scientific education in medicine and stimulated 
 needed financial support for medical education and research and for 
 teaching hospitals. Preceding the parallel activities of the licensing bodies 
 
The Background 1 1 
 
 of the individual states, the expanding program of the American Medical 
 Association and the aroused interest of universities and foundations in 
 this field of professional education resulted in the elimination of many of 
 the proprietary medical schools and "diploma mills" of that period. 
 
 In the context of the various developments sketched briefly above, the 
 memorandum letter of Mr. Edward S. Harkness of Presbyterian Hospi- 
 tal, dated December 19, 1910,* crystallized the determination of Colum- 
 bia University to provide adequate teaching facilities in the clinical divi- 
 sions of its Medical School. In that document was presented the plan of 
 operation under which the Columbia-Presbyterian Medical Center has 
 developed. The University has placed under its Faculty of Medicine 
 many educational and service responsibilities in relation to medicine, 
 public health, dentistry, nursing, and postgraduate training, and affilia- 
 tions with a number of state, municipal, and voluntary hospitals and 
 community agencies. 
 
 At the time Mr. Harkness first became interested in a possible affili- 
 ation of the College of Physicians and Surgeons with Presbyterian Hos- 
 pital, he wrote in 1910: "The scientific development of medicine has 
 especially interested me recently. The medical school constantly supplies 
 the physicians and surgeons of the future who in their early training must 
 have every facility for practical experience and application, which they 
 can only obtain at a hospital where they are taught by the practicing 
 physicians and scientific men." 
 
 At that time Mr. Harkness stated in part the following understanding 
 and conditions: 
 
 1. That the Hospital shall admit to the wards students of the medical school 
 to the extent and in the manner permitted by the most approved practice. 
 
 2. That the educational institution concerned may make nominations to all 
 positions on the Hospital staff, medical, surgical and special. 
 
 3. That the persons occupying for the time being the ranking or foremost 
 professorships in medicine and surgery in the educational institution concerned 
 shall always be nominated to appropriate positions on the staff of the Hospital. 
 
 After adoption of the affiliation plan in 191 1, the faculty of the Uni- 
 versity outlined further the aims of the school-hospital program : 
 
 I. The objects of the School of Medicine of Columbia University shall be: 
 *See Appendix A. 
 
12 The Background 
 
 a. To train men and women to be physicians of the highest type and to 
 develop leaders of medical thought; 
 
 b. To test and increase our knowledge of the art and science of medicine 
 and to foster research; 
 
 c. To apply that knowledge to the prevention, cure and alleviation of 
 human ills. 
 
 II. In planning such a school we must differentiate between that portion of 
 the entire scheme which is essential for the development of a medical 
 school designed to accommodate a definite number of students for the 
 degree of M.D., and other portions not essential to this primary purpose 
 but necessary to complete the organization to its fullest possibilities. 
 
 The letter of Mr. Harkness outlined the conditions under which the 
 hospital agreed to permit the nomination of its professional staff by the 
 University and teaching on its wards. It is well to recall that an identical 
 proposal had previously been made to the Roosevelt Hospital, then the 
 general hospital associated with the University. Roosevelt was, however, 
 unwilling to accept the conditions specified, particularly in relation to 
 the nomination of the staff by the University and the teaching on the 
 wards of the hospital, although the practice was widely accepted at that 
 time in other teaching institutions in this country and in Europe. Similar 
 suggestions had been made to Roosevelt Hospital earlier (1905 and 1908) 
 for a close teaching relationship, but the hospital authorities and the staff 
 would not agree to allow the University to organize the hospital staff 
 under the control of directors of services who would at the same time be 
 chairmen of the departments of the medical school. There were also con- 
 tinuous efforts to open the wards more freely for the use of medical stu- 
 dents as clerks and to make possible clinical, laboratory and research work 
 on patients. If it had not been for these objections, the main hospital at 
 the Medical Center today would have been Roosevelt Hospital instead 
 of Presbyterian Hospital. 
 
 The affiliation between Presbyterian Hospital and the Faculty of Med- 
 icine was logical, since a number of physicians were already on the staffs 
 of both institutions; this was the situation also with Roosevelt Hospital. 
 The affiliation between the University and Presbyterian Hospital out- 
 lined above and the formal agreement of April 25, 1911,* were brought 
 about through the efforts of Dean Samuel Lambert (dean from 1904- 
 
 *See Appendix B. 
 
The Background 13 
 
 1919),! President Butler, members of the faculty, Mr. William Sloane 
 and the Board of Managers of Presbyterian Hospital; and, above all, 
 through the vision and financial assistance of Mr. Harkness. 
 
 A number of different proposals and sites for the future Medical Center 
 were considered. Negotiations were broken off several times, leading to 
 great uncertainty about the plans. Tentative consideration was actually 
 given to the combination of Cornell and Columbia Medical Schools and 
 the New York and Presbyterian Hospitals. The First World War inter- 
 rupted many of these endeavors, although studies of the problem were 
 continued. Conferences were held with various foundations in 1917 and 
 191 8 during which a plan of full-time teaching in the clinical departments 
 was developed, a program which had already been initiated at Johns Hop- 
 kins Medical School in 1913. After years of discussion and numerous dis- 
 appointments, the present site of the Medical Center at 168th Street and 
 Broadway was finally selected in 1922. Plans were begun under the Joint 
 Administrative Board created by the agreements of 191 1 and 1921 for 
 the construction of the first units. 
 
 Dr. Samuel Lambert, who had rendered such great service in promot- 
 ing and urging the need for clinical facilities for teaching and who also 
 had assumed active leadership in developing new methods of medical in- 
 struction, resigned as dean in March, 19 19. Great credit belongs to him 
 for the determination and wisdom he exercised in developing the early 
 plans of the school. Dr. William Darrach succeeded him on July 1, 1919, 
 and served until 1930. 
 
 f See Appendix C. 
 
The Medical Center Takes Shape 
 
 Under the leadership of Dean Darrach the "Memorandum on the School 
 of Medicine"* was adopted in December, 1919. It dealt in detail with the 
 objectives, plan of organization, and steps to be taken to insure the future 
 of the school and the clinical facilities that would be required fully to 
 carry the responsibilities and opportunities of the school. This memo- 
 randum included a thorough discussion of staffing the school, particu- 
 larly the clinical departments. The document led to the revised agree- 
 ment between the University and Presbyterian dated February 10, 
 1921,1 which further consolidated the educational, research, and teach- 
 ing programs that were then evolving. The proposal included inaugura- 
 tion of the strictly full-time appointments in certain of the clinical de- 
 partments. It contemplated a nucleus of such full-time men for the pro- 
 posed Medical Center. The concept was completely supported by Dr. 
 Walter W. Palmer of the Department of Medicine, Dr. Allen O. Whipple 
 of the Department of Surgery, and their staffs. The idea also had the 
 wholehearted endorsement of Mr. Harkness and the Board of Managers 
 of Presbyterian Hospital. 
 
 The plan envisaged that a nucleus of strictly full-time men would be 
 created in each of the major departments, in which the individual physi- 
 cian would charge no fees for his professional services. This was found to 
 be impractical, however, and was changed in 1922 to a plan whereby fees 
 were charged for professional services on private patients but the re- 
 ceipts credited to a fund in the hospital to supplement salaries through 
 the University under the terms of the agreement between the two insti- 
 tutions. The chief purpose of this plan was to protect the clinical teachers 
 from the demands of private practice and thus permit them time and 
 energy to concentrate on their academic work, both instructional and 
 research. The need of office facilities at the hospital, then located at 
 Seventieth Street, to permit men in practice under a plan of geographical 
 
 *See Appendix D. fSee Appendix E. 
 
The Medical Center Takes Shape 1 5 
 
 full-time to concentrate all of their time in the hospital and teaching ac- 
 tivities became apparent early. This plan was further modified in 1923 
 when, for essentially economic reasons, some of the staff dedicated orig- 
 inally to the concept of strictly full-time shifted to the geographical full- 
 time system. 
 
 The Joint Administrative Board created by the new agreement of 192 1 
 began the task of assembling information, drawing plans, and formulat- 
 ing programs for the construction of the new center and obtaining the 
 necessary funds to carry out the undertaking. At that time Dr. C. Charles 
 Burlingame was appointed executive director of the Joint Administrative 
 Board. In 1922 he became executive vice-president of the Presbyterian 
 Hospital, a position he relinquished in 1924. 
 
 Mr. William Sloane, president of the Board of Managers of the hos- 
 pital, who had been active in the planning of the hospitals and of the 
 joint enterprise, died in August, 1922. His successor, Mr. Dean Sage, was 
 a stalwart support in the undertaking throughout the long period of 
 planning and building. Great credit belongs to him for his patient negoti- 
 ations and the wisdom and vision with which he dealt with many of the 
 complex problems that arose. He brought in Mr. John F. Bush, who was 
 appointed superintendent of the hospital March 27, 1923, to succeed Dr. 
 Charles Young, who had served in that position for seventeen years. Mr. 
 Bush became acting executive vice-president in 1924 upon the resigna- 
 tion of Dr. Burlingame from that position. He was made executive vice- 
 president in 1925, a post he held until the end of 1943. 
 
 Negotiations were initiated in 1924 with the State Hospital Commis- 
 sion which culminated in an agreement (February 24, 1926) with the 
 state of New York to build the New York State Psychiatric Institute 
 and Hospital on land provided to the state as an integral part of the new 
 Medical Center. The Sloane Hospital for Women and the Vanderbilt 
 Clinic became a part of the Medical Center by formal agreement in 1925 
 and were transferred from the management of the University to the Pres- 
 byterian Hospital. An agreement similar to that with Presbyterian Hos- 
 pital was also made with Babies Hospital on November 11, 1925, when 
 that hospital indicated its wish to join the Medical Center. It was then 
 located at 56th Street and Lexington Avenue. The Neurological Insti- 
 tute, located at 67th Street and Lexington Avenue, became affiliated 
 
1 6 The Medical Center Takes Shape 
 
 with the Medical Center on November 27, 1925, under another agree- 
 ment. The program of the new Medical Center placed responsibility for 
 teaching and research in the University and for patient care in the hos- 
 pitals. 
 
 Active plans for construction were formulated and the ground was 
 broken on January 31, 1925. On that occasion President Butler stated: 
 
 The first turning of the soil on this spot is the beginning of the fulfillment 
 of a prophecy that was made at the annual commencement of King's College 
 held one hundred and fifty-six years ago. It is the beginning of the accomplish- 
 ment of a dream that has been in the minds of many of us for a generation 
 past. It signifies that at last the two aspects of medicine — the scientific and the 
 philanthropic — are to be united in bonds that cannot be broken, as part of a 
 new and vital union of organization, of purpose, and of public service. It means 
 that a fully equipped university shall hereafter have at the service of its teach- 
 ers in medicine an ample and thoroughly modern series of laboratories and 
 clinics. It means that a noble hospital with a long record of public service be- 
 hind it, from this day forth commands the best, the very best, that science, 
 academic experience, and personal devotion can give to ground the service of 
 that hospital on the unshakable foundation of modern science in all its many- 
 sided phases. 
 
 Here on this site, through generous and broad-minded cooperation of many 
 groups, and with the princely benefactions of those whose highest concern is 
 for man, we propose to build a monument more lasting than bronze, which 
 shall testify alike to the growing power of human knowledge to minister to the 
 physical and mental ills of man and to the zeal of civilized man to help and to 
 cure his less fortunate fellows. 
 
 On the same occasion, Mr. Dean Sage, president of the Board of Man- 
 agers of Presbyterian Hospital, said : 
 
 Many years ago two partners, Columbia University and the Presbyterian 
 Hospital, conceived a vision. That vision was born of a wish to accomplish for 
 the City of New York a broad union of the forces of Medical Practice, Educa- 
 tion and Research, to the end that man might reap the benefit. 
 
 The Medical Center was opened on March 16, 1928, and the formal 
 dedication was held on October 12 of that year. 
 
The Concept of the Medical Center 
 
 The Medical Center was conceived and built to integrate functionally 
 and geographically the highest type of medical education, research, and 
 patient care. The original agreement of 191 1 and its successor of 1921 
 provided that the University should have the responsibility of nominat- 
 ing all the professional personnel on the hospital staff and that students 
 should be admitted to its wards and facilities for instruction. The feature 
 that distinguished it from the usual hospital and community service was 
 the emphasis upon the education of physicians, nurses, dentists, public 
 health officers, scientists, teachers, and other health personnel at the un- 
 dergraduate, graduate, and postgraduate levels; and upon the advance- 
 ment of knowledge in the basic sciences and its application in the clinical, 
 social, economic, and public aspects of medicine. This could be fully ac- 
 complished only through a complete geographic integration of the lab- 
 oratory, research, clinic, and hospital facilities, in order that the newer 
 scientific developments of the laboratories and research units could im- 
 mediately be placed at the disposal of those studying the mechanisms and 
 physiologic problems of illness, injury, and disability in patients, all under 
 the control and management of competent clinicians. 
 
 The successful completion of the affiliation of the University and the 
 hospitals at the Medical Center was a fresh concept which attracted gen- 
 erous support from farsighted benefactors. It represented an important 
 forward step in the development of American medicine and medical edu- 
 cation. It laid the foundation for numerous advances which the Medical 
 Center has made in the education of leaders of medical thought, in tech- 
 niques and policies of medical education, in the store of knowledge re- 
 garding human biology, and in service to the community and the nation. 
 
 From the . very beginning the Medical Center was dedicated to the 
 philosophy that it be much more than the sum total of its individual 
 parts. The success of its program has been dependent upon, and in the 
 future will be determined primarily by, the ideals and ideas which it rep- 
 resents and upon the men and the facilities that can be provided for them 
 
1 8 The Concept of the Medical Center 
 
 to attain their objectives for public services, education, and research. It 
 is an environment in which medicine of the highest standards can be at- 
 tained and learned by successive generations of well-qualified students in 
 all branches of the health sciences. The emphasis has been and must re- 
 main upon men and not upon bricks and mortar. 
 
 Dr. Samuel R. Detwiler was appointed professor of anatomy and ex- 
 ecutive officer of the department in 1927 to succeed Dr. George S. Hunt- 
 ington. Professor Detwiler served in that post until his death in 1957. 
 Dr. Hans T. Clarke succeeded Dr. William J. Gies as professor of bio- 
 chemistry and executive officer of the department in 1928. 
 
 The importance of adequate medical records for teaching and research 
 purposes was recognized from the very beginning. The earliest plans of 
 the hospital provided for an adequate record room. As early as 1929 it 
 was decided to unify all patient records through a centralized file for 
 Presbyterian Hospital, Vanderbilt Clinic, Sloane Hospital, Babies Hos- 
 pital and the Neurological Institute. Studies were made by the Medical 
 Board of the different classifications and nomenclatures of disease, and 
 after several trials a uniform system was put into effect. Shortly after the 
 opening of the Medical Center the diagnostic clinic was set up in 1929. 
 The distributing clinic was inaugurated and other administrative details 
 of this character were put into effect to implement the teaching and re- 
 search functions that were contemplated. The Social Service Depart- 
 ments of Presbyterian Hospital, Sloane Hospital and Vanderbilt Clinic 
 were consolidated in an effort to bring about integration of the profes- 
 sional services fundamental to an adequate teaching program. Dr. Rustin 
 Mcintosh was appointed Carpentier Professor of Pediatrics and executive 
 officer of the department in 1930, succeeding Dr. Herbert B. Wilcox. 
 
 A dormitory for students had been urged by Dean Emeritus Samuel 
 Lambert. Mr. Harkness responded to the joint appeal of Dr. Lambert 
 and Dean William Darrach and provided the funds for the construction 
 of Bard Hall, which was opened in 1931. 
 
 On February 1, 1931, Dr. Willard C. Rappleye was appointed Dean of 
 the Faculty of Medicine to succeed Dr. Darrach. Dr. Frederick T. van 
 Beuren, as associate dean, continued his outstanding efforts in the selec- 
 tion and admission of students. 
 
 Another addition to the Medical School of great moment was the 
 
The Concept of the Medical Center 19 
 
 building and endowment of the Institute of Ophthalmology by Mr. 
 Harkness, which was completed in 1933. It made an invaluable addition 
 to the Medical Center. 
 
 Prior to the opening of the Medical Center it had been decided that 
 all of the professional teaching would be concentrated in the new facil- 
 ities as then planned. The original plans envisaged a number of special 
 hospitals in addition to the main units that were finally constructed. 
 There had been active discussion of the University withdrawing from 
 Bellevue Hospital, where P&S had staffed the First Medical Division for 
 over a century. 
 
 It quickly became evident that not enough beds would be available in 
 the new plant even for the teaching of one hundred students in all 
 branches of medicine, particularly in view of the inability to open all of 
 the hospital wards because of the lack of funds. Hence, the decision was 
 made that reliance would still continue to be placed upon the use of 
 affiliated hospitals for supplemental teaching, such as general medicine 
 and surgery at Bellevue, Roosevelt, and St. Luke's Hospitals; tubercu- 
 losis and chest diseases at Bellevue; neurology at Montefiore Hospital; 
 and contagious diseases at Willard Parker Hospital. Through the coopera- 
 tion of those and other affiliated hospitals in both the undergraduate and 
 postgraduate areas, the Medical Center has been greatly strengthened, 
 the teaching programs have been augmented, and the firm relationships 
 with the medical profession and sister institutions in the community have 
 been maintained. 
 
 The report of the Dean of the School of Medicine for the period end- 
 ing June 30, 1 93 1, was devoted largely to a statement of the problems of 
 medical instruction. Excerpts from the report recite the general objec- 
 tives and efforts of the faculty to implement its program. 
 
 In the past, the effort has been made in most medical schools to familiarize 
 the student, as far as time, energy, and capacity permitted, with all the facts 
 and methods in every field of medicine. The hope of presenting the entire field 
 of medicine satisfactorily in the usual medical course must be abandoned as an 
 unnecessary and futile endeavor, because no individual can be expected to 
 master all phases of medicine. Furthermore, medicine cannot be taught by the 
 faculty; it must be learned by the student. It is an axiom that all true educa- 
 tion is self-education. This immediately makes the student the unit of educa- 
 tion, not the courses or the credit hours or the faculty, and requires that the 
 
20 The Concept of the Medical Center 
 
 methods of medical education shall be essentially those of graduate education 
 in distinction to those of secondary education, which are still so widely em- 
 ployed in many of our colleges, universities, and medical schools. The aim is 
 to adjust the training to differences in the capacities, interests, and methods of 
 study of different students and to place greater responsibility upon the student 
 for his own training. 
 
 The primary purpose of the medical school is to provide opportunity for 
 self-education. The early work, which is largely in the medical sciences, the 
 principles of which are likely to remain the basis of sound medical practice, re- 
 search, and public health work in the future, is not to be looked upon as 
 isolated courses nor alone as the foundation of medical training, for they also 
 serve as a scaffolding upon which the structure of clinical experience is built. 
 Every effort is being made to correlate the medical sciences with the clinical 
 problems and to emphasize the unit of the entire medical course in its purpose 
 to equip the student to deal soundly and intelligently with the health prob- 
 lems of the individual and the family, rather than to provide a series of isolated 
 experiences and technical procedure of various medical sciences and clinical 
 specialties. Stress is placed in the clinical training upon the patient as a whole, 
 and more attention is being given to the various economic, social, home, em- 
 ployment, emotional, and other factors which are often of great value in diag- 
 nosis, treatment, and prevention, and which are often responsible for the 
 medical profession. 
 
 Conditions of modern living are partly responsible for mental and emotional 
 distortion in an increasing number of people and are leading to an appreciable 
 increase in the nervous and mental disorders, particularly in the functional 
 disorders, many of which produce serious impairment and often are mistaken 
 for organic disease. Our meager understanding of the underlying mechanisms 
 of many of the mental, emotional, and functional disorders is comparable to 
 that which existed in regard to general medicine fifty years ago, before the in- 
 troduction of accurate, measurable criteria of study which transformed medi- 
 cine and surgery from mysticism, empiricism, and guesswork to what in many 
 instances now approaches scientific certainty. 
 
 No field of medicine has received so much publicity and propaganda on as 
 uncertain and insecure a basis as the nervous and mental disorders. This is un- 
 fortunate, for the problem is one of the most important health, educational, 
 and public problems of our time, and there is urgent need of at least a few 
 fundamental studies in this field. It is hoped that the special facilities and op- 
 portunities at the Medical Center may be organized to conduct investigations 
 which may throw some light on the character of these disorders, an under- 
 standing of which is the first requisite for sound diagnosis, treatment, and pre- 
 vention. Sufficient funds are not provided as yet to make an effective attack 
 on the problems involved. 
 
 One of the most important developments of the year was the announcement 
 
The Concept of the Medical Center 21 
 
 of the University's program in postgraduate medical education. The Univer- 
 sity and the New York Post-Graduate Medical School and Hospital entered 
 into an affiliation through which certain phases of postgraduate medical edu- 
 cation will be developed jointly by these two institutions. All segments of the 
 postgraduate program are closely related to each other and particularly to the 
 basic training of medical students, including interns, in which significant 
 changes are being made. Artificial segregation of portions of the educational 
 process is to be discouraged if serious gaps in the training of physicians are to 
 be avoided. No part of the basic medical training, the hospital and graduate 
 experience, or the continuation education of the specialist and general practi- 
 tioner should be isolated. The University's program in medicine should be a 
 unit and the educational endeavors in the various aspects of medicine wherever 
 conducted under University responsibility should be closely correlated. 
 
 Provision for the proper training of clinical specialists is probably the most 
 important immediate problem for the University in this field, because the 
 groundwork for serious endeavor has already been laid and other activities in 
 postgraduate education can be developed most satisfactorily in relation to such 
 training. Each laboratory and clinical department of the Medical School is 
 participating in graduate work now and considerable numbers of graduate 
 students are in training. The University has satisfactory affiliations with fifteen 
 hospitals in its program of medical education and placed interns in forty-one 
 hospitals of Greater New York from this year's graduating class. It would 
 seem logical to evolve a scheme of postgraduate education through the various 
 contacts already established, in which case the program of the University 
 would develop largely out of the present arrangements and in other hospitals 
 that desire similar affiliations, rather than through a scheme which would dis- 
 place or duplicate the satisfactory relations that now exist and which should be 
 developed further. 
 
 Special attention may be directed toward the frequent references in these 
 reports of cooperation between different departments of the school, which are 
 an indication that the purpose of the Medical Center is being accomplished. 
 The interweaving of the activities of the various departments is already break- 
 ing down the watertight compartment arrangement which has existed in medi- 
 cal faculties for many years, and is bringing a unity to the medical faculty, 
 medical instruction, and medical research that could not be accomplished in 
 any other way. 
 
 The other point to which special attention may be called is the wide field of 
 research activities of the various departments. A number of very important 
 fields of medicine are being investigated, and contributions of scientific and 
 public interest are likely to come from these endeavors. Many of these investi- 
 gations have been supported by funds and financial aid from outside the Uni- 
 versity. 
 
 Conditions of medical service are undergoing significant changes, partly in- 
 
22 The Concept of the Medical Center 
 
 fiuenced by social and economic factors and partly because of factors within the 
 profession itself. There is a growing appreciation that medicine is as much a 
 social as it is a biological science, and many of the most difficult problems of 
 the profession in the near future are likely to be those associated with the 
 adaptation of modern medical knowledge and with the organization and sup- 
 port of trained personnel to meet the health needs of the community. Efforts 
 to solve these problems are multiplying in many sections of the country and in 
 recent years there has been a marked increase in industrial medicine, student 
 health services, salaried medical work, insurance medicine, and group practice, 
 as illustrations. These are the broad problems of medical economics to which 
 the University should give some attention. We have an unusual opportunity 
 to study some of these problems and have a responsibility to our students, the 
 medical profession, and the community to inquire into the basic principles in- 
 volved. 
 
The Educational Program 
 
 The geographic distribution of the student body at the time of the in- 
 auguration of the Medical Center revealed that about 84 percent of the 
 graduates in the previous ten years had come from the New York area 
 and only 16 percent from outside its environs. Sixty-five percent of the 
 recent graduates of the school at that time located in New York State, 
 in sharp contrast with those previous to 1910. Other studies of the types 
 of practice in several decades formed the further basis for the evaluation 
 of the educational plans of the school. 
 
 In 1932 a study was made of more than 500 recent graduates regarding 
 the quality of the work of the internships which these men had taken. It 
 was known that one of the weaknesses in the over-all education of physi- 
 cians was the hospital period. It was rapidly becoming recognized that 
 the basis for true graduate education was through the development of 
 residencies and fellowships. At that time an adviser on internships was 
 appointed as a further step in helping students to secure advice and sug- 
 gestions regarding their hospital period of training. It was the opinion of 
 the faculty that the type of service in the hospital period is not nearly as 
 important as the opportunities which are provided for the right kind of 
 training. The debate between the merits of the straight versus the rotat- 
 ing internship was active. The popularity of some of the hospital ap- 
 pointments was traceable to the opportunities provided in the institu- 
 tions for the intern to do major surgery. It was the conclusion that 
 neither the short rotating service which provides a hurried, superficial 
 experience in many departments, nor the usual straight service limited 
 to a single field meets the needs of most students. The so-called mixed 
 internship has been developed in a number of hospitals to combine the 
 virtues and avoid the less desirable features of both. 
 
 The Curriculum Committee continued to study the problems of the 
 teaching program largely through the creation of free periods and elec- 
 tives; and stimulation of the students to individualize their learning and 
 the faculty to adjust the training to differences in capacity, interests, 
 
24 Educational Program 
 
 preparation, and methods of study of individual students. As a further 
 step in the liberalization of the attitude toward medical education, the 
 faculty in 1932 discontinued the number of specific requirements for ad- 
 mission in a real endeavor to emphasize the importance of a general pre- 
 professional education rather than one concentrated on the medical 
 sciences alone. The Committee on Admissions at that time adopted a 
 policy under which preference would be given in the selection of stu- 
 dents "to those who, in the opinion of the Committee on Admissions, 
 present evidence of high achievement in their college education and who 
 are most likely to succeed in medicine, rather than to those who present 
 the largest number of course credits and who have limited their prepara- 
 tion to the premedical sciences." The administration of the student pro- 
 gram was also strengthened when the faculty adopted the formal resolu- 
 tion and made it a part of the announcement of the school stating that 
 "it reserves the right to refuse readmission or promotion to any student 
 who is believed for any reason to be unsuited to the conditions of study 
 in this school." This was another emphasis upon the attention being paid 
 to the personal qualifications of the individual and his promise of becom- 
 ing a competent, ethical, and sound physician. 
 
 The program at the New York Post-Graduate Medical School and 
 Hospital, affiliated with the University in 1931, was undergoing scrutiny 
 and study. There were numerous difficulties in dealing with the situation 
 because of the physical separation of the two institutions. This was partly 
 solved by the appointment of the Dean as director of the Post-Graduate 
 in 1933, a post he held until the dissolution of the affiliation in 1947. The 
 differences in educational philosophy, the divergence of opinion in re- 
 gard to qualifications for admission to postgraduate courses, and of edu- 
 cational standards; the offering of specialty training to largely unselected 
 practitioners; and lack of adequate financial support and other consid- 
 erations introduced many problems which were to beset the Faculty for 
 more than a decade. 
 
 One of the challenges in the early period of the Medical Center devel- 
 opment was the attempt to integrate dentistry into the general program. 
 The School of Dental and Oral Surgery, before its move to the Medical 
 Center, had had only nominal University connection. Important steps 
 were taken to provide facilities in the new buildings, although the struc- 
 
Educational Program 25 
 
 ture itself was not easily adapted to the requirements of a dental clinic 
 or school. The instruction in the basic medical-dental sciences and the 
 management of the clinical departments were carried out essentially as 
 an independent faculty. 
 
 Another area of active discussion was that of nursing education, partic- 
 ularly in relation to the possibility of developing nursing practice and 
 education independently of those of medicine. It was the general opinion 
 of the faculty that a sound educational plan for nursing would be an im- 
 portant contribution which the University could make and that the con- 
 tent and methods of education could best be carried out if guided and 
 supported by the Faculty of Medicine. The leaders of the faculty were 
 familiar with the fundamental sciences upon which nursing is dependent. 
 In 1932 the faculty decided to recommend to the Trustees the creation 
 of a Department of Nursing in the Faculty of Medicine. 
 
 In 1934 suggestions were reported to the Board of Managers of the 
 Presbyterian Hospital and the University that the basic course in nurs- 
 ing become an integral part of a larger educational program designed not 
 only as a sound preparation for the usual practice of bedside nursing but 
 also as a foundation for further education in the field of public health 
 nursing, school and industrial nursing, nursing school administration, and 
 other phases of nursing practice and education. 
 
 The new plan provided for the needs of several groups of students. 
 Students who had previously had two or more years of acceptable college 
 work were to receive the Bachelor of Science degree from the University 
 upon satisfactory completion of the course in nursing. These students 
 would be taught in sections of their own and be given advanced work 
 commensurate with their previous preparation. Students already holding 
 a baccalaureate degree acceptable to the University and to the New York 
 State Education Department would be granted advanced credit amount- 
 ing to nine months, thus enabling them to complete the basic course in 
 two years and three months. Students who had a high school diploma or 
 its equivalent acceptable to the University and the New York State 
 Education Department would enter the three-year basic course and re- 
 ceive credit for two years of college work toward a Bachelor of Science 
 degree upon completion of the course. 
 
 In November, 1935, Miss Margaret E. Conrad was appointed the first 
 
26 Educational Program 
 
 professor of nursing, with a seat on the Faculty of Medicine. On July i, 
 1937, the Department of Nursing of the Faculty of Medicine was 
 created. 
 
 Another major problem of that period which received a good deal of 
 attention was the highly uneven financial burden of sickness, which falls 
 heavily on some portions of the population and which was greatly exag- 
 gerated in the depression years. It was clearly understood at that time 
 that there was need of developing some plan, adapted to the conditions 
 in this country, which would make modern medical services available to 
 everyone. Special emphasis was placed on the fact that any plan proposed 
 should be designed to preserve and maintain the high quality of profes- 
 sional care — medical, nursing, and hospital. The widespread propaganda 
 for certain forms of sickness insurance and other devices which might 
 lead to a reduction of these responsibilities to mere terms of economy, 
 organization, and mediocrity might do more harm than good in the long 
 run. Frequently these efforts by outside groups to solve the purely eco- 
 nomic phases of medical care neglected to consider fully the highly tech- 
 nical and professional problems involved. 
 
 Associated with this whole field of medical economics was the impor- 
 tant question of the so-called distribution of doctors and the supply of 
 physicians for the country. Again it was the direct concern of the faculty, 
 as it participated in the national effort, to insure an adequate number of 
 physicians capable of rendering medical services of high quality. These 
 and other aspects of medical education, broadly conceived in relation to 
 the teaching, research, and hospital responsibilities of the Medical Center, 
 were presented and considered by the faculty on numerous occasions. 
 
 Dr. Alan R. Anderson was appointed secretary of the Administrative 
 Board on Postgraduate Studies in February, 1932, a post in which he 
 served until January, 1934. 
 
The Depression Period 
 
 In December, 1932, the Babies Hospital was united with Presbyterian 
 Hospital, a forward step of great importance in the teaching and over-all 
 functioning of the Medical Center. Dr. Clarence O. Cheney succeeded 
 Dr. George H. Kirby as professor of psychiatry and executive officer of 
 the department on February 1, 1933. The faculty, through the Com- 
 mittee on Admissions, was making every effort to maintain an enrollment 
 of students of high quality. 
 
 It was a common experience here and elsewhere that many students 
 coming from college were not able fully to utilize elective periods to the 
 greatest advantage. This was due in part to the fact that the usual college 
 preparation for medicine does not provide students with the initiative, 
 resourcefulness, and maturity necessary for independent study. It was 
 generally recognized that opportunities should be provided through flex- 
 ible curriculum arrangements for students who had special aptitude and 
 also who might well profit by more independent research and inquiry. 
 Those with promise and ability were permitted to elect part of their 
 course, although it was expected that all would obtain a sound prepara- 
 tion in that body of medical knowledge which accumulated experience 
 indicated as necessary for safe and competent practice. Even at that 
 early date, the rearrangement of the curriculum provided active partici- 
 pation of the students in the affiliated hospitals, which have always been 
 a rich source of supplemental training. 
 
 As early as 1933 emphasis was being placed upon the need of financial 
 aid for students. The report of the Dean for the year ending June 30, 
 1933, may be quoted: 
 
 The need of more scholarships and other means of financial aid for our stu- 
 dents is particularly pressing during this trying economic period. If it had not 
 been for the generous loan policy of the University and the receipt of income 
 from a few endowed scholarships, a number of students would have been 
 obliged to discontinue their professional studies. A student employment office 
 was created in the Dean's Office. One hundred and five students found em- 
 ployment during the year. 
 
28 Depression Period 
 
 The expenses and the heavy schedule which precludes self-support make the 
 problem of financing a medical education following a long period of preliminary 
 and college education a serious and often insurmountable problem for the par- 
 ents and students. Many students of promise and ability are lost to the profes- 
 sion because of the financial difficulties of securing their training. In the long 
 run, the profession and the country are the losers. If we had more aid for the 
 students, the knowledge of such assistance would encourage more of the ablest 
 college students to enter upon the study of medicine. 
 
 The growing interest of the faculty in the education of specialists in 
 the clinical fields was evident by the creation of standards for graduate 
 medical education based in large part on the established plans for such 
 recognition in Denmark. This lead to the creation of the degree of Doctor 
 of Medical Science in February, 1934. This was a step in the direction of 
 helping to formalize the organization of the instructional program in the 
 specialty fields. This was particularly significant since the Dean helped to 
 draft the requirements for the newly created Advisory Board for Medical 
 Specialties in 1933 as a part of the efforts of the medical profession, li- 
 censing authorities, and the medical schools to establish standards and 
 certification for specialists throughout the country. The Dean served on 
 that board from 1933 to 1944 and as president from 1937 to 1944. The 
 announcement by the University of such a recognition of adequate spe- 
 cialty training, particularly with emphasis on the basic sciences as well as 
 clinical competence, was an important contribution at the time. 
 
 During 1934 further steps were taken to integrate the program of the 
 New York Post-Graduate with that of the University through appoint- 
 ments of six members of the Post-Graduate staff to the Faculty of Med- 
 icine. Provisions were made that the Post-Graduate Hospital would make 
 appointments to its staff only on the nomination of the University, paral- 
 leling the procedure employed in certain other affiliated hospitals. 
 
 Methods of nominating the staffs of Presbyterian Hospital, Babies 
 Hospital, and the Neurological Institute were modified during the year, 
 and the procedure was simplified. This was accomplished in 1934 by an 
 amendment to the 1921 agreement. 
 
 The affiliation with the School of Tropical Medicine at San Juan, 
 Puerto Rico, begun in 1926, had been making good progress. The arrange- 
 ment offered unusual opportunities for certain members of the Medical 
 School to carry on research there. An interchange of staff between the 
 Medical School and the School of Tropical Medicine had been most pro- 
 
Depression Period 29 
 
 ductive and offered the University an unique opportunity to participate 
 in various studies of medicine in the tropics. 
 
 In 1934 graduate medical education, as distinguished from postgrad- 
 uate offerings for the men in practice, was emphasized. Efforts were be- 
 gun to secure additional laboratory space in which graduate students of 
 the Medical School and the affiliated hospitals might carry on studies 
 in the sciences basic to the specialty in question. It was decided that 
 more space should be added to the scientific and clinical departments as 
 well as animal quarters, and that these additions should be fully inte- 
 grated with the existing departments to insure adequate supervision and 
 direction of the programs. 
 
 In the same year the undergraduate course was lengthened from thirty- 
 one to thirty-four weeks, partly to insure compliance with licensing re- 
 quirements of certain states. This created a departure from the normal 
 university calendar. 
 
 At that time most of the affiliated hospitals did not have laboratory 
 facilities or the full-time staff adequately to provide the necessary in- 
 struction, research opportunities, and educational advantages. It was 
 stated that "through the hospitals, clinics, and laboratories associated 
 with it, the University can offer a comprehensive and satisfactory train- 
 ing in all of the fields of advanced clinical medicine. The hospital and 
 clinical facilities can be expanded through other affiliations when more 
 resources are needed and opportunities of high quality present them- 
 selves. The almost unlimited hospital facilities of New York offer a unique 
 opportunity and responsibility in the field of graduate medical education, 
 which at the moment is the weak link in the medical program of the 
 country." 
 
 Dr. Raymond B. Allen was appointed associate dean in charge of 
 graduate studies and director of the New York Post-Graduate Medical 
 School and Hospital on July 1, 1934. Dr. Frederick T. van Beuren, Jr. 
 resigned as associate dean, a post he had held since 1921. He was suc- 
 ceeded by Dr. Edward Cathcart. Dr. Benjamin P. Farrell was appointed 
 professor of orthopedic surgery and executive officer of the department 
 on July 1, 1934. 
 
 In recognition of the growth of specialization in medical practice and 
 education, the Trustees, upon the recommendation of the faculty, created 
 the Departments of Radiology and Urology in 1935. This was done 
 
30 Depression Period 
 
 partly to provide academic status for these specialties in keeping with 
 the recognition which they now enjoyed in national organizations and 
 the specialty boards. Parallel with the progress being made in the under- 
 graduate training, the postgraduate courses for practicing physicians at 
 Mount Sinai, the New York Post-Graduate Medical School, DeLamar 
 Institute of Public Health, Montefiore Hospital, the New York State 
 Psychiatric Institute, and other affiliated institutions were going forward 
 as important contributions in helping to keep physicians in practice 
 abreast of new developments. Certain of the departments at the Medical 
 Center participated in these endeavors. 
 
 The great need of proper facilities in the community for the care of 
 chronic diseases and the growing importance of these disabilities in med- 
 ical teaching and research had engaged the special attention of the City 
 of New York for several years. The then Commissioner of Hospitals, Dr. 
 Sigmund S. Goldwater, had created the Research Council in Chronic 
 Diseases and had approached the University for aid in implementing the 
 highly desirable program. Negotiations were started with the city which 
 ultimately led to the creation of the affiliation with the Hospital for 
 Chronic Diseases, later named the Goldwater Memorial Hospital. 
 
 Another community development of significance to the faculty and the 
 program at the Medical Center was the Hospital Survey for New York 
 in which the Dean took an active part. Professor Haven Emerson was 
 chosen director of that study. 
 
 In a reorganization of the School of Dental and Oral Surgery, started 
 in 1933, the Dean of the Faculty of Medicine was made Dean of that 
 school, a post which he held until 1945 when the two faculties were 
 merged. 
 
 The research activities of the departments were going forward with 
 vigor. Particular attention was given to studies of intermediary metab- 
 olism with the aid of heavy hydrogen, one of the pioneering experiments 
 which later turned out to be monumental in regard to radioactive iso- 
 topes and other studies of nuclear energy. This was done in cooperation 
 with Professor Harold C. Urey of the Department of Chemistry, and 
 with Professor R. Schoenheimer. These and other contributions were at- 
 tracting wide attention to the quality and range of research undertaken 
 at the Medical Center. 
 
The Post-Depression Years 
 
 Discussions were being held with the New York City Department of 
 Health looking toward the possibility of development of a stronger 
 teaching program in the field of public health. Proposals brought forward 
 at that time indicated the desire to provide training opportunities 
 for members of the Department of Health, the Visiting Nurse Service, 
 Family Relief and Social Service Agencies through the creation of 
 appropriate courses adapted to the needs of a variety of such personnel. 
 
 As a result of the discussions, extended over a period of more than a 
 year, the city of New York decided to build the Washington Heights 
 Health and Teaching Center at the corner of 168th Street and Broad- 
 way. This site, chosen after considerable debate, did have some disad- 
 vantages in preempting space that might otherwise be used for the future 
 development of Vanderbilt Clinic. Final agreement on this program was 
 arrived at in 1936.* The construction of the building was begun in April, 
 1938, and the building was completed in 1939. The Washington Heights 
 Health and Teaching Center was opened in 1940. 
 
 In 1935 the Skin and Cancer Hospital, later known as the Stuyvesant 
 Square Hospital, became a part of the New York Post-Graduate Medical 
 School and Hospital. It brought to the postgraduate teaching program a 
 wealth of material and a strong staff as a skin and cancer unit. 
 
 The efforts at the School of Tropical Medicine, now in its ninth year 
 of affiliation with the University, were making excellent progress. 
 
 Dr. John B. Kernan was appointed professor of otolaryngology and 
 executive officer of the department in 1935, to succeed Dr. Cornelius G. 
 Coakley. 
 
 In 1936 the needs of graduate medicine continued to occupy the at- 
 tention of the faculty. It was recognized during this period that an es- 
 sential part of the plans for the future of the Medical Center must in- 
 clude graduate medicine and that such an undertaking should be put into 
 operation at the earliest possible moment if the Medical Center were to 
 
 *See Appendix F. 
 
32 Post-Depression Years 
 
 provide the leadership expected of it. The chief need was for adequate 
 laboratory facilities in which physicians and residents in hospitals at the 
 Medical Center and those affiliated with the University might receive 
 training and conduct investigations in their chosen fields. 
 
 The problem of cancer began to occupy a more prominent part of the 
 thinking of the faculty because it represented a major challenge to med- 
 ical science and clinical medicine. It was recognized that knowledge of 
 this malady in its various forms would have to be developed particularly 
 from advanced studies in the underlying sciences. It was clear that there 
 was need for financial support and facilities to provide a coordinated at- 
 tack upon this crippling and killing disorder. 
 
 At that stage the Department of Hospitals of the city entered into con- 
 ferences with the administration in regard to the possibility of the city 
 building a modern cancer hospital on Welfare Island. It was pointed out 
 to the city authorities that a cancer hospital would require acute medical 
 and surgical services and an active staff of physicians. These would be 
 hard to provide on the Island because of transportation and other difficul- 
 ties. It was suggested that the city contemplate building such a cancer 
 hospital somewhere on the island of Manhattan. Reference is made later 
 to the negotiations leading to the ultimate building of the Francis Dela- 
 field Hospital. 
 
 In 1937 construction of the new laboratories to be used primarily for 
 graduate students working in the basic medical sciences of anatomy, 
 physiology, pathology, bacteriology, and chemistry was begun. Facilities 
 for the new building were intended to accommodate residents in hospitals 
 affiliated with the Hospital as well as those working at the Medical Center 
 and to provide much needed opportunities for those working in the med- 
 ical sciences basic to training in the graduate fields. This program was 
 made possible through the generous aid of the Commonwealth Fund and 
 the Martha M. Hall Foundation, together with assistance from the Josiah 
 Macy, Jr., Foundation for support of graduate research and teaching. At 
 the time there were sixty-two students in thirteen different departments 
 working for the degree of Doctor of Medical Science. 
 
 The city began construction of the Hospital for Chronic Diseases on 
 Welfare Island, later known as the Goldwater Memorial Hospital. The 
 plan called for a unit for teaching and research in chronic diseases and 
 
Post-Depression Years 33 
 
 for undergraduate as well as graduate instruction. The Medical School 
 was placed in charge of one of the divisions of this unit. 
 
 Dr. Charles A. Flood was appointed assistant dean on July 1, 1936, to 
 replace Dr. Edward Cathcart, who resigned to resume practice. Dr. 
 Lawrence W. Sloan was appointed assistant dean in charge of graduate 
 studies to replace Dr. Raymond B. Allen, who resigned to accept the 
 deanship of Wayne University Medical School. Dr. Nolan D. C. Lewis 
 was appointed professor of psychiatry, executive officer of the depart- 
 ment, and director of the New York State Psychiatric Institute and Hos- 
 pital to succeed Dr. Clarence O. Cheney, who resigned on June 30, 1936. 
 
The Momentum Resumed 
 
 During 1937 a review of the program of the Medical Center and an out- 
 line of the future needs was completed, including an appraisal of the ex- 
 tent to which the Medical Center had fulfilled the functions contem- 
 plated in the initial proposals. The original program visualized a group 
 of hospitals and educational facilities balanced in relation to the three 
 major functions of such a center. The review confirmed the early memo- 
 randa for the Medical Center in the light of current needs and conditions 
 and indicated the wisdom, flexibility, and soundness of those earlier plans. 
 The direction of developments had continued uninterrupted. There were 
 no suggestions or indications for changes in the policies adopted in the 
 beginning. The study reached the conclusion that the foundation was 
 laid securely for one of the great contributions to American medicine. 
 The review particularly emphasized five immediate needs: 
 
 "1. Full integration of the Neurological Institute with the Presby- 
 terian Hospital together with financial aid to provide a nucleus of full- 
 time men and an increase in the amount of free care on the wards." 
 
 (This recommendation was implemented as far as possible in the pro- 
 fessional reorganization of the staff in the Department of Neurology in 
 1938 and 1 94 1 and the final administrative integration of the Neuro- 
 logical Institute in 1944 with Presbyterian Hospital, at which time the 
 latter assumed full financial responsibility for the Institute. This assured 
 the stability and adequate support of the ward services.) 
 
 "2. Financial support for the full development of the program of grad- 
 uate medical education, particularly in supplementing the budgets of the 
 medical sciences and for fellowships for graduate students." 
 
 (The addition to the Medical School of eight floors of laboratories for 
 graduate medicine and two floors for cancer research in 1937 went far 
 toward answering the needs in these fields. It was an important step for- 
 ward in the Medical School's obligation in regard to this phase of medical 
 education and research.) 
 
The Momentum Resumed 35 
 
 "3. Provision for low-priced private services for persons of moderate 
 means in a separate hospital building, to the extent of accommodating 
 those of the junior staff who have active teaching, hospital, and clinic 
 responsibilities." 
 
 (Presbyterian Hospital has expanded its semiprivate facilities. The ad- 
 dition to Harkness Pavilion in 1936 was an important increase in facilities 
 to accommodate physicians on the staff who were on a part-time or a 
 geographical full-time basis. Private practice offices were added on the 
 fourth floor of Harkness Pavilion in 1945 as a further help in meeting the 
 needs of the Medical Center.) 
 
 "4. Assignment of all semiprivate beds in the main hospital to the 
 teaching ward services. In the instance of medicine, some of these beds 
 may well be utilized for dermatology. Most of those of surgery could best 
 be used for cancer patients." 
 
 (This proposal was satisfied in part by the assignment of ward beds to 
 dermatology in 1954. Later the program of the Francis Delafield Hospital 
 discussed elsewhere provided beds for cancer patients and research labo- 
 ratories for this field.) 
 
 "5. More facilities for housing hospital staff and personnel." 
 (The hospital undertook commutation for many of the house staff and 
 personnel and made improvements in the living quarters.) 
 
 The less immediate needs described in the review of 1937 were: 
 
 "1. Development of adequate facilities for the study and treatment 
 of cancer." 
 
 (A solution to this need appeared in sight shortly after the review, as 
 described later.) 
 
 "2. Expansion of the program of the School of Dental and Oral 
 Surgery." 
 
 (Aside from minor alterations, there has been no noteworthy progress 
 in the Dental School although the full integration of the Faculties of 
 Dentistry and Medicine in 1945 was an important step forward.) 
 
 "3. Additional support of research and teaching in public health." 
 (The Washington Heights Health and Teaching Center was opened in 
 
36 The Momentum Resumed 
 
 1940. The first class in hospital administration was admitted in 1945. 
 This program became one of the leading educational efforts in this field 
 in the country. The Institute of Administrative Medicine, an outgrowth 
 of the program, was created in 1950. The name of the School was changed 
 to the School of Public Health and Administrative Medicine in 1955.) 
 
 "4. Increase in the facilities for dermatology." 
 
 (This recommendation was finally implemented in 1955 through the 
 conversion of ward units on the Medical Service for the use of this 
 specialty.) 
 
 "5. Provision for intramural convalescent patients." 
 (The development of the Mary Harkness Convalescent Home was 
 started in 1937, which helped the situation significantly. There was grow- 
 ing interest in this field, and later in 1947 an affiliation was worked out 
 with the Institute for the Crippled and Disabled, as a further expansion 
 of physical medicine and rehabilitation, medical care, research, and 
 teaching.) 
 
 "6. A unit for communicable diseases." 
 
 (The school and hospital had been dependent upon the Willard Parker 
 Hospital for teaching in communicable diseases and the care of patients 
 suffering from such disorders until that institution was discontinued in 
 December, 1955. A small unit was finally established in 1952 in Presby- 
 terian Hospital for intra-institutional needs. This modest provision has 
 proved to be satisfactory.) 
 
 "7. A unit for bone and joint disorders." 
 
 (Negotiations extended over many years with the New York Ortho- 
 paedic Dispensary and Hospital and were finally consummated when that 
 hospital moved to the Medical Center in 1950. Teaching had been con- 
 ducted in the Orthopaedic Hospital for many years, and full integration 
 of that unit with the Medical Center greatly strengthened the teaching 
 and investigation in this important area of medical service and education, 
 even though the educational funds of the Orthopaedic Hospital were re- 
 tained by Presbyterian.) 
 
 "8. Extension and support of a more comprehensive program of nurs- 
 ing education." 
 
The Momentum Resumed 37 
 
 (The program for developing the Department of Nursing in the Fa- 
 ulty of Medicine begun earlier was progressing and ultimately resulted in 
 the creation of a full-fledged Department of Nursing in the Faculty of 
 Medicine, as described elsewhere.) 
 
 Dr. Horatio B. Williams resigned as executive officer of the Depart- 
 ment of Physiology and Dr. Magnus I. Gregersen was appointed to the 
 post on July 1, 1937. Dr. Frederick Tilney retired from the post of 
 executive officer of the Department of Neurology in 1937 to devote him- 
 self to research. 
 
 An important step forward was taken in 1938 when the Neurological 
 Institute became more closely integrated with the Presbyterian Hospital, 
 a development which had been slowly evolving ever since the Medical 
 Center was opened. Through financial aid from the Rockefeller Founda- 
 tion and generous support of the Presbyterian Hospital, a plan of or- 
 ganization was concluded. Dr. Walter W. Palmer was appointed execu- 
 tive officer of the Department of Neurology and medical director of the 
 Neurological Institute, effective January 1, 1938. Dr. Robert F. Loeb 
 was made associate medical director. 
 
 The opening of the graduate laboratories made possible a strong pro- 
 gram in the graduate fields not only for the candidates for the degree of 
 Doctor of Medical Science but for the numerous residents of the Medical 
 Center as well as from the affiliated hospitals. This proved to be a major 
 step forward in the widening concept of American medical education. 
 
 The requirements of the various specialty boards as well as the needs 
 of those seeking higher education were stimulating necessary changes in 
 the internship and residency experience for the recent graduates, as scien- 
 tific knowledge was expanding and the demands of medical care were 
 growing. The statement made by the Commission on Medical Education 
 that "an emphasis on educational principles in medical training and 
 licensure can be secured only by modifying the point of view and broad- 
 ening the interests of those responsible for medical education and li- 
 censure, not by recommendations, statistics, new regulations, further 
 legislation, or manipulation of the curriculum" was receiving attention. 
 The school was participating in this evolution and assisting in the devel- 
 opment of the Advisory Board for Medical Sepcialties. 
 
 In 1939 negotiations were finally completed for the integration of the 
 
38 The Momentum Resumed 
 
 Herman Knapp Memorial Eye Hospital with the Institute of Ophthal- 
 mology. The Knapp Hospital was closed in 1940 and the patients as well 
 as the endowments for free beds were transferred to the Presbyterian 
 Hospital. The unrestricted funds of the Knapp Hospital and later the 
 money received from the sale of the hospital property were set up as the 
 Knapp Memorial Foundation of the University for the support of re- 
 search and graduate education in the field of ophthalmology. 
 
 Dr. George F. Cahill was appointed professor of urology and executive 
 officer of the department on November 1, 1939 to replace Dr. }. Bentley 
 Squier, who retired. Dr. Charles A. Flood resigned as assistant dean to 
 enter private practice. Dr. Lawrence W. Sloan resigned as assistant dean 
 in charge of graduate studies, and Dr. Vernon W. Lippard was appointed 
 to succeed Dr. Sloan. 
 
 Discussions were being actively carried out during 1940 in regard to 
 the plans of the city to build a cancer hospital. The gift of the south 
 property by Mr. Edward S. Harkness in 1938 opened the possibility of 
 assigning a portion of that land for a cancer hospital as an important 
 addition to the resources of the Medical Center. The area consisted of 
 seven acres. A two-and-one-half-acre plot was offered to the city for a 
 hospital for cancer patients and research. Initial plans were made for the 
 hospital, designated originally by Mayor Fiorello H. La Guardia as the 
 Florence Nightingale Hospital, later named the Francis Delafield Hos- 
 pital.* Construction of the hospital was started in 1940 and was held in 
 abeyance during the war. Construction was resumed after peace was de- 
 clared, but there were delays because of the decision by Presbyterian 
 Hospital in 1944 not to provide the steam and power for the unit. That 
 required planning for a power plant for the Delafield unit. Construction 
 was finally completed and the institution was opened in 1950. 
 
 The death of Mr. Edward S. Harkness on January 29, 1940, marked 
 the loss of the greatest benefactor of the Medical Center. His foresight, 
 wisdom, and generosity made the Medical Center a reality. It stands as 
 an imperishable monument to his memory. 
 
 In 1940 the Francis Delafield Alumni Professorship in Pathology was 
 activated. This fund was created originally in 1928 when the Alumni 
 Association of the College of Physicians and Surgeons gave the Univer- 
 sity the major part of its resources with the agreement that the income 
 
 *See Appendix G. 
 
The Momentum Resumed 39 
 
 from this fund would be accumulated until the principal sum reached 
 $200,000, at which time the Delafield Professorship would be created. 
 This generous support of the Alumni Association deserves special recog- 
 nition. 
 
 Dr. Haven Emerson retired on June 30, 1940, as executive officer of 
 the DeLamar Institute of Public Health, and Dr. Harry S. Mustard was 
 appointed professor of public health practice and director of the Institute 
 on July 1, 1940. Dr. Francis Carter Wood retired as the first director of 
 the Institute of Cancer Research. Dr. William H. Woglom was appointed 
 acting executive officer of the new Department of Cancer Research on 
 January 26, 1940. Dr. A. Raymond Dochez was appointed the first John 
 E. Borne Professor of Medical and Surgical Research and executive 
 officer of the Department of Bacteriology on July 1, 1940, following the 
 death of Dr. Gay. 
 
 The utilization of the graduate laboratories continued at a high level. 
 In 1940, 194 residents in the hospitals cooperating in the program par- 
 ticipated in instruction in the laboratories of the school. This particular 
 field of medical education received widespread national attention and 
 became the subject of a study by the Commission on Graduate Medical 
 Education (1 937-1 939), of which the Dean was the chairman. He was 
 also chairman of the Committee on Internships of the Association of 
 American Medical Colleges and president of that association ( 1 938-1939) , 
 as well as being active in the Advisory Council on Medical Education 
 (president from 1939 to 1944). All of these agencies were dealing with, 
 among other matters, the problems of internship, residency training, and 
 postgraduate instruction. 
 
 Another feature of interest which was beginning to have an impact on 
 hospitals and medical schools, and indirectly upon medical education, 
 was the growth of voluntary prepayment hospital insurance. This had 
 started in 1929 and was now reaching national dimensions. The faculty 
 was taking cognizance of this new development on the horizon and much 
 of the Dean's .report for the year ending June 30, 1940, was devoted to 
 this new aspect of American medicine. At this period also the Dean 
 served as Commissioner of Hospitals of the city of New York (1940- 
 1942) and participated actively in the city's management of war prepara- 
 tions. 
 
The Second World War 
 
 It was becoming increasingly evident in 1 939-1 940 that this country 
 would probably become involved in the World War. This had direct and 
 indirect effects on the activities of the school and the staffs of the hos- 
 pitals. Preparations were begun by the medical schools of the country for 
 possible acceleration of the medical school schedules under a Committee 
 on War Activities of the Association of American Medical Colleges, of 
 which the Dean was chairman (1 939-1 942). Plans were being made to 
 insure continuance in medical school of students who would be needed in 
 the military services if this country became involved in the struggle. It 
 was apparent that the probability of military service for most able-bodied 
 young physicians inevitably would interfere with the educational pro- 
 gram. Not only would a large number of recent graduates and members 
 of the staff be called for service, but a reduction in the number of resi- 
 dents in hospitals would obviously lead to increased responsibilities and 
 demands on those who remained. This could only result in a sacrifice of 
 time for training in the basic medical sciences, a situation which did 
 actually occur. The reduction in the number of physicians available for 
 instructional duties and civilian practice would introduce other special 
 problems. 
 
 Dr. Tracy J. Putnam was appointed executive officer of the Depart- 
 ment of Neurology on July 1, 1941. 
 
 After the outbreak of hostilities the demand for postgraduate courses 
 on the part of the practicing physicians was great. It developed that 
 many physicians had left civilian practice to enter the military services, 
 and those remaining had found it necessary to bring themselves up to 
 date in different phases of medical practice in areas in which their col- 
 leagues had assumed responsibility earlier. Many others were taking 
 courses better to prepare themselves for military service. The net result 
 was a large enrollment of practicing physicians for short courses offered 
 under the University through its affiliated hospitals. 
 
 The impact of the war upon medical education in this country in 1942 
 
The Second World War 41 
 
 was clear-cut and immediate. The problems of the schools related to the 
 whole question of national manpower and particularly the maintenance 
 of an adequate supply of physicians for the military and for the civilian 
 population. Following the recommendation of the Committee on War 
 Activities of the Association of American Medical Colleges in 1941, the 
 accelerated program for medical instruction was inaugurated. The plan 
 had been partly introduced to avoid the necessity for the Selective 
 Service deferment of individuals who in the normal course enjoyed six- 
 teen weeks of vacation. The plan worked out by the committee repre- 
 sented a real contribution to the war effort by making five thousand more 
 doctors available than normally would be graduated in the three follow- 
 ing years. This school conformed to the recommendation and beginning 
 in July, 1942, students were admitted at intervals of nine months instead 
 of annually. 
 
 Special problems grew out of the program, among which was the ques- 
 tion of state licensure. These difficulties were presented through the 
 Committee on War Activities to the Federation of State Medical Boards 
 and to the individual state licensing authorities. Cooperation in this joint 
 undertaking was complete. Special amendments to some of the medical 
 practice acts became necessary. The Dean served as chairman of the 
 Executive Council of the Association of American Medical Colleges dur- 
 ing the period of 1 942-1944. 
 
 Reduction in the premedical courses for the period of college prepara- 
 tion for medical studies had threatened to reduce seriously the educa- 
 tional qualifications of students going into medicine. It was hoped that 
 this would be an emergency situation limited to the period of the war, 
 because the long-term effects of such reduction in the standards were 
 obvious. Not only was the number of years of the preprofessional period 
 to be reduced, but it was to be condensed into a curriculum of fifteen 
 months. 
 
 In view of the accelerated program's relation to the internship, adjust- 
 ments in the hospital schedules were required. Of far greater significance 
 was the induction of assistant residents and residents, and the reduction 
 in the number of such physicians on the house staffs of hospitals. 
 
 The deferment of preprofessional students was a special problem be- 
 cause without it the ultimate supply of physicians would be greatly re- 
 
4 2 
 
 The Second World War 
 
 duced. Arrangements were made under the Selective Training and Serv- 
 ice Act of 1940, and further administrative devices were set up through 
 the Army Specialized Training Program and the Navy College Training 
 Program to meet the situation. Also a lowering of the draft age intro- 
 duced special difficulties in the matter of assuring the recruitment of 
 medical students. 
 
 Throughout this hectic period the faculty and students of the school 
 concentrated on their prime objectives. The withdrawal of many mem- 
 bers of the staff and the accelerated program threw heavy burdens on 
 those who remained at home, many of whom had to be persuaded that 
 their national duty was to remain as essential teachers. Invaluable assist- 
 ance was provided through this period by the Procurement and Assign- 
 ment Service of which the Dean was an active member. Individuals on 
 the faculty, in addition to their many additional responsibilities at the 
 school, served on numerous committees, local and national, in connec- 
 tion with the war program. They were also called upon by various gov- 
 ernmental agencies for advice. They gave unstintingly of their time and 
 talents. 
 
 As the war activities progressed, the school and the hospitals at the 
 Medical Center were called upon to give graduate courses for medical 
 officers of the armed forces in many areas, such as plastic and maxillo- 
 facial surgery, neurological surgery, anesthesiology, laboratory proced- 
 ures, and many fields related to the military effort. There was a serious 
 shortage of graduate nurses as well as house staff. 
 
 Dr. Aura E. Severinghaus was appointed assistant dean in 1942. 
 
 By 1943 the school, along with other phases of American life and edu- 
 cation, had turned to the all-out war effort. The endeavor to produce 
 well-trained physicians for the military and civilian needs of the country 
 met with a large measure of success considering the many handicaps pre- 
 sented. Yet it was vital for the long-term needs of the country that in 
 serving the immediate objectives of the war, there should not be serious 
 impairment of the sound foundations of medical education built up dur- 
 ing the previous twenty-five years. 
 
 It was recognized by the faculty in the midst of the storm that it would 
 be faced with many new problems which would have to be met when the 
 primary war task was completed. It already began to undertake tentative 
 
The Second World War 43 
 
 plans for the new opportunities that would present themselves at the 
 termination of the global conflict. It was fully recognized that this effort 
 could only be formulated in theory, because at that time there was no 
 way of knowing the length of the struggle or the extent to which our 
 strength and resources would be expended. That there would be a period 
 of economic readjustment of the first magnitude seemed certain. Never- 
 theless, our faculty undertook plans for the opportunities ahead. One of 
 the first problems the Medical School would have to face would be the 
 readjustment of the program to a more normal pattern as soon as peace 
 was established. The emergency actions, such as the accelerated program, 
 would have to be quickly readjusted to the needs of peace time. 
 
 The death of Dean Sage, president of the Board of Managers of Pres- 
 byterian Hospital, Babies Hospital and the Board of Directors of Neuro- 
 logical Institute in July, 1943, brought profound sorrow to everyone 
 associated with the institution. The Medical Center is in no small measure 
 a monument to his vision, courage, and wisdom. The professional staffs 
 of the hospital and the school as well as future generations of students 
 will always be deeply indebted to him. Mr. Sage was succeeded in July, 
 1943, by Mr. Charles P. Cooper, a trustee of the Neurological Institute 
 and a member of the Board of Managers of Presbyterian Hospital. 
 
 In 1944 the Barnard M. Baruch Committee on Physical Medicine 
 made a grant of $400,000 to the school to expand and strengthen the on- 
 going program in rehabilitation of ex-service men and civilians. It 
 afforded an opportunity for the school and hospital to launch a modern 
 plan in the field of physical medicine and rehabilitation. The school con- 
 tinued its contributions of postgraduate courses for civilian doctors and 
 discharged military medical officers. 
 
The Review of 1944 
 
 In 1944 it was felt essential that another study of the program of the 
 faculty and the Medical Center be undertaken to appraise the progress 
 being made and to review certain of the objectives. It was gratifying to 
 report that substantial advances had been made since the review of 1937. 
 The integration of the program of the Neurological Institute with the 
 other hospital units had been accomplished, effective January 1, 1944. 
 The plan of centralizing all of the teaching and research activities and 
 most of the diagnostic services had gone forward satisfactorily. Nursing 
 education under University direction and close cooperation with the 
 Hospital had lead to a strong program on the basis of which new plans 
 for graduate instruction in this professional field were being developed. 
 The Washington Heights Health and Teaching Center had greatly 
 strengthened the teaching and research in public health and laid the 
 foundation for a contribution of national importance. Financial aid was 
 also received for expansion of the efforts in the field of tropical medicine. 
 
 The decision had been reached earlier that the Medical Center as a 
 whole and the Medical School in particular should not be expanded be- 
 yond the size originally planned for undergraduate instruction of ap- 
 proximately 100 medical students and fifty dental students per class, to- 
 gether with a limited amount of sound graduate instruction in the clin- 
 ical and related specialties. The strengthening and utilization of affiliated 
 hospitals for graduate and undergraduate teaching had worked out satis- 
 factorily and was made effective in a large measure by the laboratories 
 for graduate medicine completed in 1938. 
 
 The opinion was well developed that there should be increased ward 
 services in the Department of Medicine. The Medical Service in Pres- 
 byterian Hospital was regarded as inadequate for the teaching needs and 
 supervised experience for a student body of one hundred students per 
 class. It was, and still is, the policy of the school that every student should 
 be exposed to the intensive basic clinical clerkship of the third year in the 
 Department of Medicine. This has been possible, however, only by sched- 
 
Review of 1944 45 
 
 uling one-fourth of the class through the summer vacation period when 
 those students obtain their third-year clerkship in advance of the regular 
 academic year. 
 
 The recommendation in 1937 emphasized the need for facilities for 
 teaching and research and the methods of diagnosis, treatment, and pre- 
 vention of disorders of the locomotor system. This would require better 
 training in the specialty skills of medicine, surgery, physical therapy, re- 
 habilitation, and occupational therapy, as related to the injuries and 
 diseases of bones and joints. The war experience indicated that about 70 
 percent of the battle casualties involved the extremities. 
 
 It was agreed by the faculty that orthopedic surgery, as now under- 
 stood by leaders in the field, should be included in the program of the 
 Medical Center. Further negotiations were carried on looking to the 
 ultimate integration into the Medical Center of the New York Ortho- 
 paedic Dispensary and Hospital, with which the University had been 
 affiliated for many years. Progress in this direction was being made with 
 the idea of a combined orthopedic program with the long established 
 and excellent fracture service of the Presbyterian Hospital. It was recom- 
 mended by the Medical Board that a single orthopedic service for adults 
 and children and for fractures be created. 
 
 Another field of special significance because of the war casualties was 
 plastic surgery. A number of outstanding leaders were on the staff of the 
 Medical Center. The same applied to thoracic surgery in which a number 
 of the staff had wide experience during the war and were available to de- 
 velop these programs. 
 
 On May 12, 1944, a conference was held with representatives of the 
 city Planning Commission, the city Departments of Health, Hospitals, 
 and Public Works, the Public Health Research Institute, and the Uni- 
 versity looking forward to a program for the building at the center of a 
 joint undertaking in the field of public health, to include the laboratories 
 of the Department of Health and a hospital for tropical diseases. The 
 University and Presbyterian Hospital agreed to make available the land 
 between Riverside Drive and the West Side Drive for this purpose. The 
 contracts for this plan were for a period of five years, subject to renewal. 
 The renewal was made at the expiration of the first five-year period, but 
 the plan finally expired in 1955. 
 
46 Review of 1944 
 
 Construction was begun shortly after the end of the war on the cancer 
 hospital at the south property known as the Florence Nightingale Hos- 
 pital (later the Francis Delafield Hospital). It was clear that this hospital 
 would provide unexcelled opportunities for research, treatment, and ad- 
 vanced training in all phases of malignancy, as well as facilities of great 
 service to the community, the hospitals, and the teaching program. 
 
 The problems of dentistry and the growing importance of this profes- 
 sion in many aspects of health and medical care, and the natural develop- 
 ment of specialization in it, led to further efforts to secure more support 
 for this phase of the University program. Only minor progress could be 
 reported in this important area. 
 
 A special study of nursing education had been made. It was the opinion 
 of those participating that the most effective educational plan indicated 
 that the enrollment of undergraduate student nurses should be limited 
 to no students in the first-year class and 100 in each upper class. The 
 general program had been progressing satisfactorily along the lines orig- 
 inally outlined. The problem of housing for undergraduate nurses and 
 those from affiliating institutions made it clear that the numbers could 
 not be adequately cared for without an expansion of the nurses' home. 
 The conclusion was reached that there was an additional need for under- 
 graduate, affiliating, and graduate nurses, which led ultimately to the 
 building of the Edward S. Harkness Memorial Hall in 1947. 
 
 Another review of the Medical Center program was made in 1944. It 
 emphasized particularly : 
 
 "1. Enlargement of Harkness Pavilion." 
 
 (The seventh and eleventh floor extensions of Harkness Pavilion in 
 1951 were steps toward the solution of this question.) 
 
 "2. Combined orthopedic and fracture service." 
 (This was solved in 1950 by the move of the New York Orthopaedic 
 Dispensary and Hospital to the Medical Center.) 
 
 "3. Dermatological service." 
 
 (This was finally accomplished in 1955 on a modest basis.) 
 
 "4. Plastic surgery service." 
 
 (Partially solved by the assignment of beds on the Surgical Service.) 
 
Review of 1944 47 
 
 "5. Housing for undergraduate nurses." 
 
 (The additions to Anna C. Maxwell Hall in 1946 solved this problem 
 satisfactorily.) 
 
 "6. Housing for graduate nurses." 
 
 (The completion of the Edward S. Harkness Memorial Hall in 1947 
 and the beginning of leasing of outside apartments solved this situation.) 
 
 "7. Expansion of operating rooms (Floor P)." 
 (This was completed in 1951.) 
 
 "8. X ray expansion (Floor C)." 
 
 (Partially solved by additions and rearrangement of facilities.) 
 
 "9. Additional elevator service." 
 
 (Much had been accomplished by temporary improvements. The final 
 solution was reached in 1958 through the decision to replace all of the 
 main elevators in the hospital with modern installations.) 
 
 "10. Increase dining room and kitchen facilities." 
 
 (Expansion of dining room and kitchen facilities in 1950-195 1 and 
 more planned for 1 958-1 959 under the new expansion as recommended 
 by the Joint Committee on Facilities of the Faculty and Medical Board.) 
 
 "11. Miscellaneous alterations and storage space." 
 (Many adjustments and improvements completed.) 
 
 "12. Enlargement of Vanderbilt Clinic." 
 
 (One floor was added in 1951 at the time the New York Orthopaedic 
 Dispensary and Hospital was moved to the Center, and the laboratories 
 of the Institute of Cancer Research were built in 1951. The facilities of 
 Vanderbilt Clinic need further expansion.) 
 
 "13. Alterations to Babies Hospital." 
 
 "14. Alterations to Eye Institute." 
 
 "15. Alterations to Neurological Institute." 
 
 (Part of large readjustments recommended in 1 957-1 958 studies by 
 the Joint Committee on Facilities.) 
 
 "16. Expansion of Dental School." 
 (No progress in this area.) 
 
48 Review of 1944 
 
 "17. Facilities for tropical and communicable diseases." 
 (A small unit for communicable diseases was added in 1952, largely for 
 local patients and personnel.) 
 
 "18. Increased facilities for public health teaching and research." 
 (The Washington Heights Health and Teaching Center solved the 
 problem for a time. Later in 1 956-1 958 the need for additional facilities 
 in this important area became crucial. Negotiations have been carried on 
 to secure outside space at 21 Audubon Avenue and efforts are being 
 made [1958] to secure the purchase of that building for the urgent Uni- 
 versity's needs.) 
 
 "19. Additional library facilities." 
 
 (The overload on the library had been partly cared for at the south 
 property and storage at the Butler Library at the campus. The facility 
 is greatly overcrowded and was one of the major appeals of the Bicen- 
 tennial Fund in 1954. In 1957 it was one of the major units of the pro- 
 posed new library-auditorium-laboratory addition to the Medical Center 
 recommended by the Joint Committee on Facilities of the faculty.) 
 
 "20. Additional diagnostic and therapeutic laboratories." 
 (Construction in 1951 of four floors for the Institute of Cancer Re- 
 search assisted in part in decompressing the plans of the Medical School 
 for laboratory areas such as surgical pathology. The rapidly continuing 
 growth and demand for diagnostic laboratory services had continued to 
 make this problem acute. The need for more research laboratories and 
 better teaching facilities continued urgent.) 
 
 "21. Intramural convalescent hospital." 
 
 (This item was under active consideration in the development of other 
 concepts of physical rehabilitation. The needs have been partly met 
 through the affiliation in 1947, extended in 1952, with the Institute for 
 the Crippled and Disabled and the program of the Mary Harkness Con- 
 valescent Home in 1937.) 
 
 Mr. John S. Parke was appointed executive vice-president of Presby- 
 terian Hospital on January 1, 1944, to succeed Mr. Bush, and served in 
 this post until his death on August 13, 1954. 
 
The Postwar Period 
 
 One of the acute problems of this period was meeting the responsibility 
 for discharged medical officers. The professional program of medical edu- 
 cation and training for many of these men was abbreviated by the ac- 
 celerated program or partially interrupted by the war. Another impor- 
 tant group embraced those physicians who went from established prac- 
 tices and served during the war period in restricted areas of professional 
 activities, and who then needed short intensive refresher courses to pre- 
 pare them to return again to civilian life. Efforts were made to meet the 
 challenge of these two groups. In the first instance hospital residencies 
 and fellowships were provided. The plans consisted of education on spe- 
 cialty services and advanced instruction in certain of the basic sciences 
 as outlined in a general way by the Advisory Board for Medical Special- 
 ties and by certain universities such as ours. Large numbers of young 
 men were entitled to and needed the additional training. This threw a 
 burden on the medical schools to formulate and augment existing pro- 
 grams in the basic sciences, and on the hospitals to provide residency 
 opportunities during a turbulent period of their own adjustment back 
 to normal operation. 
 
 Most of the second group required short refresher courses so that they 
 might reequip themselves for practice in their local communities. The 
 school took an active part in this endeavor and fortunately was in a 
 position to make an important contribution to this responsibility because 
 of the residency training, the laboratory facilities created a few years 
 earlier and through the cooperation and established instructional pro- 
 grams in the affiliated hospitals. 
 
 Another important problem was the reestablishment as promptly as 
 possible of the level of premedical education to insure the return to ade- 
 quate standards of admission. The wartime requirement of only fifteen 
 months of college preparation, as prescribed by the Army Specialized 
 Training Program, for example, was clearly insufficient. Many of the 
 difficulties related to medical licensure and irregularities in training 
 
50 Postwar Period 
 
 which had to be considered and readjusted. Another item of significance 
 was the necessary changes in the medical course itself. The teaching 
 schedules were quickly returned to the accepted minimal standards of 
 medical education. Specialization had received new impetus, and the 
 matter of hospital residencies and the admission to postgraduate courses 
 had to be reviewed and evaluated. 
 
 The curriculum itself also had to undergo restudy. New emphasis 
 based particularly on the experience of the war period was placed upon 
 disease prevention, early diagnosis and treatment, the psychosomatic and 
 emotional problems of medical diagnosis, and a wide range of related 
 questions. Serious revision of the whole medical schedule was suggested. 
 
 New attention was given to the economic and social aspects of medi- 
 cine, changes in the composition of the population, emphasis upon such 
 areas as parasitology, medical and health problems of the tropics, chemo- 
 therapy, the special diseases of adult life and old age, biophysics, genetics, 
 industrial medicine, legal medicine, the care and treatment of trauma, 
 nutrition, the correction of physical defects, the maintenance of physical 
 and mental fitness, aviation physiology, and a wide range of environ- 
 mental factors in health as well as in disease. It seemed necessary to re- 
 view and reexamine the whole structure in the light of these develop- 
 ments and present-day requirements. The faculty dedicated itself to this 
 reexamination and continued for several years the revision and improve- 
 ment of the schedule and methods of instruction. 
 
 Dr. George H. Humphreys II was appointed assistant dean in charge 
 of the postgraduate program on January i, 1944. Dr. James W. Jobling 
 retired as Delafield Professor of Pathology and executive officer of the 
 department, and Dr. Harry P. Smith succeeded him on July 1, 1945. 
 Dr. Harry B. van Dyke was appointed Hosack Professor of Pharma- 
 cology and executive officer of the department on October 1, 1944, suc- 
 ceeding Dr. Charles C. Lieb who had served in the post since 1929. 
 
 Throughout 1945 the efforts outlined were continued and expanded. 
 Progress was being made in some of the proposals made in 1944, particu- 
 larly in relation to the housing of nurses, modification of certain ward 
 floors of the hospital, and freeing space necessary for the combined ortho- 
 pedic and fracture service. The city authorities had decided to build the 
 Public Health Center between Riverside Drive and the West Side Drive, 
 
Postwar Period 5 1 
 
 although this never came to fruition. Generous support was received 
 from one of the foundations to augment the program in tropical medi- 
 cine. The Trustees decided during the year to integrate the School of 
 Dental and Oral Surgery with the Medical Faculty, which gave new 
 impetus to the close correlation of the teaching and research in that im- 
 portant health field with the fundamental sciences and the clinical fields 
 of medicine. 
 
 The administration of Presbyterian Hospital proposed to the Univer- 
 sity in 1946 a new agreement to replace that of 1921 under which the 
 Medical Center took form, was built, and had been operated. The sug- 
 gestion aimed at modifying some of the authority of the University in 
 the matter of nominating the hospital staff. Since an essential feature of 
 the original concept of the Medical Center was to create a University 
 hospital to the mutual advantage of both institutions (which time had 
 already proved abundantly), the University decided that it should not 
 abandon the original plan and did not accept the proposal. The sugges- 
 tion in another form was made again by the hospital in 1950, at which 
 time that proposal was also found unacceptable. 
 
 One of the most urgent needs was reemphasized, namely, that of the 
 library. It was pointed out that during the previous fifteen years, the 
 demand on the library had increased 250 percent, the attendance had 
 increased about 700 percent. The facilities at the time the Medical Center 
 was built had been known to be inadequate. New demands were being 
 made upon the library as the institutions increased the intensity of their 
 programs and such units as the Francis Delafield Hospital, the Public 
 Health Center, and the New York Orthopaedic Dispensary and Hospital 
 were being brought into the Medical Center. 
 
 It was becoming clear that additional laboratories for research and 
 teaching were urgently needed. Owing to a lack of funds at the time the 
 Medical Center was built the facilities of some of the basic science de- 
 partments had been reduced below those provided at the old school at 
 Fifty-ninth Street. The reduction of space was accomplished in part by 
 shortening the main building of the school by twenty-three feet, which 
 explains why the western wing of the Medical Center does not go all the 
 way to the street on 168th Street. In retrospect, it would have been 
 wiser to have eliminated from the original plans one or more floors on 
 
5 2 
 
 Postwar Period 
 
 top of the structure. The pressure of the scientific staff was increasing 
 steadily, particularly in the light of developments in chemotherapy, 
 biophysics, virology, physical medicine, cancer research, endocrinology, 
 and many other fields in which new instruments and techniques of study, 
 diagnosis, and treatment were being developed. The urgency was doubly 
 emphasized because of the rapidly expanding financial support being 
 provided for research from governmental, foundation, industrial, and 
 private sources. The immediate pressure was for more facilities. 
 
 Another feature of great importance, particularly in reference to the 
 hospital activities, was the growing emphasis upon accommodations for 
 semiprivate patients. Special consideration was being given to the na- 
 tional trend toward prepayment insurance for hospital services and to- 
 ward group practice aimed at providing more satisfactory and more 
 economical medical care for self-supporting persons of moderate means. 
 These developments required attention particularly, because of the re- 
 sponsibility of the University to provide professional staffs for the new 
 cancer hospital and the Presbyterian Hospital units. 
 
 The adjustment to the peacetime basis of medical education was going 
 forward with greater speed and satisfaction than could have been pre- 
 dicted. It had been found that one of the great difficulties in operating 
 the accelerated program had been the fact that about one-third of the 
 instructional staff had gone into the military services. Thus it meant 
 that two-thirds had been teaching twelve months of the year. Not only 
 had the clinical staff been obliged to do more teaching but had to care 
 for more patients, including those of community and staff doctors who 
 had gone into military duties. The critical situation of the accelerated 
 program proved to be a staff matter rather than just adjustments in the 
 school schedules. 
 
 The abbreviated preparation of many of the students had been another 
 serious fact. Probably the most unsatisfactory effect of the accelerated 
 educational plans had occurred in the hospital internship and the resi- 
 dencies. These had been shortened, against the advice of the medical 
 schools of the country, but the postwar plans discussed elsewhere indi- 
 cated the earnest efforts made to recapture that training. 
 
 In considering the plans for the readjustments in the postwar period, 
 an attempt was made to define the obligation of medical education as 
 
Postwar Period 53 
 
 that of producing a sufficient number of adequately trained physicians 
 to meet the future needs of the entire population. Every effort was made 
 by the faculty to visualize those trends, and as far as possible, to predict 
 the requirements, recognizing that the content of the course itself must 
 of necessity include a common denominator of the basic obligations of 
 medical practice as well as develop habits and methods of study in the 
 student which would enable him to continue his self-education through- 
 out his career. 
 
 It was recognized that graduate training would have to assume greater 
 responsibility for a considerable part of the instruction given in past 
 years in the specialties during the undergraduate course. The latter in 
 turn was shifting its objectives to the presentation of basic principles and 
 the common ground of general and specialty practice, with particular 
 emphasis upon the development in the individual of intellectual power, 
 resourcefulness, interest, curiosity and judgment concerning scientific 
 evidence; a better grasp of the mechanisms of diseases; and his responsi- 
 bilities for long-term competence throughout his career. More attention 
 was being placed on the emotional and psychological factors in many 
 illnesses because it was argued that current medical education and practice 
 was overemphasizing the mechanics and techniques of science. 
 
 The new social and economic developments as they had an impact on 
 medicine were also being clearly recognized, with medicine being re- 
 garded as a social as well as a biological science. The changing attitude of 
 the faculty was reflected in the recommendations to the Trustees that 
 the DeLamar Institute of Public Health created in 1921 be designated 
 the School of Public Health. This was done in 1945. 
 
 In the period of readjustment following the war and the rapid curtail- 
 ment of the Army Specialized Training Program and the Navy College 
 Training Program, an acute need for scholarship aid for students de- 
 veloped. It was expected that a considerable number of future students 
 would probably be eligible for benefits under the Servicemen's Readjust- 
 ment Act of 1944, although it was realized that many students might 
 exhaust their allowance while still in college preparation for medical 
 studies. A few would be eligible under Public Law 16 and the state vet- 
 erans scholarships. These anticipations were fully realized as incoming 
 students presented themselves for admission. 
 
54 Postwar Period 
 
 Miss Margaret E. Conrad was appointed associate dean (Nursing) on 
 July i, 1945. Dr. Bion R. East was appointed professor and executive 
 officer of the Department of Dental and Oral Surgery and associate dean 
 (Dental and Oral Surgery) on the same date. Dr. Harry S. Mustard was 
 appointed DeLamar Professor of Public Health Practice and associate 
 dean (Public Health). 
 
 In January, 1945, the Psychoanalytic Clinic for Training and Research 
 was created, the first program of its kind established under University 
 auspices. It proved to be an important contribution to University train- 
 ing and research in psychiatry. 
 
 As time passed the demand for graduate and postgraduate instruction 
 continued heavy. Thousands of medical officers were released from the 
 military service each month, and a large proportion sought further train- 
 ing leading either to specialization or completion of the requirements of 
 the specialty boards or opportunities for reorientation before assuming 
 civilian practice. Practically all of the two hundred postgraduate con- 
 tinuation courses for practicing physicians in affiliated hospitals were 
 filled. 
 
 In response to the request of the Veterans Administration, the faculty 
 joined with other medical schools of the city in a joint deans' committee 
 which has the responsibility of organizing and directing the teaching and 
 resident staff of the Kingsbridge Hospital. The program was extended 
 further to include the nomination of consultants and full-time staff. The 
 Dean was the first chairman of the New York Deans' Committee and 
 helped organize the staff of the Veterans Hospital. 
 
 New instructional programs were set up in the Dental School for re- 
 turning officers and practitioners which contributed materially in help- 
 ing forward this phase of professional education. A comprehensive sched- 
 ule of refresher courses varying in duration from two weeks to four 
 months were offered. The Trustees of the University granted funds for 
 the inauguration of fellowships for graduate dentists in six basic medical 
 sciences to stimulate and encourage well-qualified dental teachers and 
 research workers. 
 
 Dr. Benjamin P. Watson, professor of obstetrics and gynecology and 
 executive officer of the department since 1926 retired on June 30, 1946. 
 He was succeeded by Dr. Howard C. Taylor, Jr. on July 1. Dr. Allen O. 
 
Postwar Period 55 
 
 Whipple retired as Valentine Mott Professor of Surgery and executive 
 officer of the department on September 30, 1946, and was succeeded by 
 Dr. George H. Humphreys II. Dr. Phillips Thygeson, executive officer 
 of the Department of Ophthalmology, resigned to enter private practice. 
 Professor John H. Dunnington was made executive officer from January 
 1, 1946. 
 
 Dr. Vernon W. Lippard, associate dean in charge of graduate studies, 
 resigned to become dean of the Louisiana State University School of 
 Medicine. He was succeeded by Dr. John B. Truslow. Dr. Edwin G. 
 Zabriskie was appointed acting executive officer of the Department of 
 Neurology on July 1, 1946, and served until June 30, 1948. 
 
 On April 30, 1947, the affiliation between the University and the 
 New York Post-Graduate Medical School and Hospital was terminated. 
 During the sixteen years of joint effort a substantial contribution was 
 made to the philosophy of graduate and postgraduate medical education 
 through the setting up of adequate standards of admission to those post- 
 graduate courses, particularly in the specialty fields. Many of the short 
 offerings were refocussed primarily for the needs of physicians in general 
 practice. Numerous programs were added during the war and in the im- 
 mediate postwar period which were a great help to the profession. 
 
 On June 27, 1947, Columbia University entered into an agreement* 
 with St. Luke's Hospital to provide facilities and opportunities for under- 
 graduate medical education and the training of interns and hospital resi- 
 dents. Essentially similar agreements were drawn up with the Mary 
 Imogene Bassett Hospital in Cooperstown, New York, and with Roose- 
 velt Hospital. 
 
 *See Appendix H. 
 
Continuing Self-Appraisal 
 
 Studies of the responsibilities and future of the Medical Center were 
 continued with a special review and detailed study of the curriculum 
 conducted by the Committee on Instruction under the chairmanship of 
 Associate Dean Severinghaus. The resulting improvements and modern- 
 ization were widely recognized by other schools. It was clearly recognized 
 by the faculty that professional education today is a never-ending pro- 
 cess, beginning in the early periods preceding admission to medical school 
 and passing successively through undergraduate training, the internship, 
 graduate preparation for either general practice or a specialty through 
 the hospital residency, and the continuation education of the physician 
 in practice throughout his career, in order that he may be kept abreast 
 of new knowledge and methods. It has always been recognized that the 
 primary function of the basic course is not the preparation of a fully- 
 educated doctor, but the endeavor to train the minds of students in order 
 that they may develop discerning and critical judgement to evaluate evi- 
 dence of illness and disability, and sympathetically to advise and guide 
 patients in problems involving the health of themselves and families. 
 
 It was evident that the national changes in economic and social philos- 
 ophy were having a definite bearing on the forms of practice and the re- 
 sponsibility of the profession in present-day society. Medicine had be- 
 come alert and responsive to the public concern regarding the welfare of 
 the entire population, since the health and vigor of its people is the 
 greatest single asset of any nation in time of peace as well as in periods 
 of the stress of war. It was becoming increasingly clear that the American 
 public had been aroused and was demanding better medical and health 
 services for every element of the population, regardless of economic status 
 or geographic location. Medical practice is not only a private pursuit but 
 a community responsibility. These and other considerations were con- 
 stantly in the minds of the teaching staff, who kept readjusting the in- 
 structional programs to meet the shifting needs of students as future 
 practicing physicians, scientists, and teachers. 
 
Continuing Self- Appraisal 57 
 
 The faculty undertook certain changes in the instructional program, 
 particularly in emphasizing that the crucial element was the individual 
 student upon whose character, aptitude, preparation, ability, and in- 
 dustry the results of medical training so largely depended. The aim was 
 to focus upon the development of minds capable of appraising evidence 
 and drawing conclusions through logical reasoning. It seemed only proper 
 that provisions should be made in the national interest for those students 
 with superior qualifications, regardless of their economic status. This 
 philosophy led to renewed efforts on the part of the staff and the admin- 
 istration to secure additional scholarship aid to make such an objective 
 possible. 
 
 Another major responsibility of the University that was receiving 
 special attention was the development of research and the advancement 
 of scientific knowledge both in the clinical fields and the basic sciences. 
 At this time consideration was given to the creation of a series of insti- 
 tutes. It was proposed that the research activities be interdepartmental. 
 The institute represented a device for grouping such cooperative activi- 
 ties without in any way interfering with the normal departmental or- 
 ganization, administrative responsibilities, or teaching duties. Among the 
 suggestions made in 1948 were: 
 
 The Institute of Cancer Research (surgery, gynecology, biochemistry, pathol- 
 ogy, endrocrinology, medicine, clinical specialties, immunology, cancer re- 
 search, pharmacology) 
 
 The Institute of Aging (medicine, physiology, pathology, biochemistry, anat- 
 omy, psychiatry, neurology) 
 
 The Institute of Human Reproduction (obstetrics, gynecology, physiology, 
 endocrinology, psychiatry, urology) 
 
 The Institute of Rehabilitation (orthopedic surgery, medicine, surgery, anat- 
 omy, physiology, physical medicine, psychiatry, neurology) 
 
 The Institute of Social Medicine (medicine, health education, dentistry, medi- 
 cal economics, hospital administration, public health practice, industrial 
 medicine, rural medicine, nursing, business administration, sociology, clinical 
 departments) 
 
 The Institute of Cardiovascular Disorders (medicine, surgery, pediatrics, 
 physiology, pharmacology, pathology, neurology) 
 
 The Institute of Medical-Dental Disorders (surgery, oral surgery, dentistry, 
 plastic surgery, medicine, cancer research, otolaryngology) 
 
 The Institute of Nutrition (pediatrics, medicine, physiology, dentistry, sur- 
 gery, cancer research) 
 
58 Continuing Self- Appraisal 
 
 It was self-evident that the further growth of the Medical Center re- 
 quired additional physical facilities, although at all times the real empha- 
 sis was on the qualifications and competence of the personnel, staff as 
 well as students. The University had adopted a liberal and flexible policy 
 in regard to the joint staffs of the hospitals and the Medical School. 
 There was agreement that a nucleus of strictly full-time men should be 
 continued in the major clinical departments who would be responsible 
 for the general direction of the educational and research programs and 
 the selection of the members of the staff. This group should be supple- 
 mented by a substantial number of practicing physicians who were quali- 
 fied and interested in teaching and for whom accommodations at the 
 Medical Center would have to be created if such individuals were to 
 make their maximal contributions. This led to the further expansion of 
 the geographical full-time plan under which offices and facilities for 
 private patients were provided. 
 
 One of the recommendations of the faculty in 1948 was a "unit com- 
 prising private offices, diagnostic laboratory facilities and private room 
 accommodations for about two hundred additional beds in a separate 
 unit so located and constructed as to allow for future expansion, if indi- 
 cated. This facility probably should be built essentially as a group prac- 
 tice unit which may be adapted later for those of the insurable or insured 
 group of the employed population. It is probable that in the near future 
 a substantial proportion of the population will have some form of pre- 
 payment medical care insurance, including a large fraction of the patients 
 admitted into the wards of the hospitals at the Medical Center. It would 
 appear urgent that the first major consideration is that of facilities for 
 the part-time teaching staff, particularly those who do, or in the future 
 will, enjoy the privileges of geographic fulltime." 
 
 The serious shortage of ward teaching beds in the Department of Med- 
 icine continued. When the Medical Center was originally built it was 
 planned that there would be two hundred beds for the Medical Service. 
 The number has never been more than one-half of that total. The situ- 
 ation was created by the lack of funds to finance and maintain a sufficient 
 number of beds for teaching and research purposes in the major clinical 
 departments of the school. The situation from the beginning has been 
 met by utilization of Bellevue, Goldwater Memorial, Seaview, St. Luke's 
 
Continuing Self- Appraisal 59 
 
 and Roosevelt Hospitals in the city and the Mary Imogene Bassett Hos- 
 pital at Cooperstown. 
 
 Research is the life blood of education. Laboratory and research activi- 
 ties are today as important a part of the concept of a medical center as 
 are ward beds and clinics. Only such institutions can in the long run at- 
 tract and hold the highest quality of teachers, clinicians, and investi- 
 gators. One of the most urgent needs of the Medical Center is that of 
 more laboratory facilities, not only for teaching but more particularly 
 for the development of the staff and graduate students, the training of 
 teachers and investigators badly needed in other medical schools, hos- 
 pitals, government and public agencies, and for contributing to the ad- 
 vancement of knowledge, improvement of health care, and the explora- 
 tion of newer methods of diagnosis, treatment, and prevention of disease. 
 
 The faculty has recognized increasingly the important and rapidly de- 
 veloping fields of fundamental research in malignancy. This problem in- 
 volves in varying degrees basic knowledge and methods of investigation 
 in practically every one of the basic sciences as well as in most of the 
 clinical departments. There exists in the faculty and in the various units 
 at the Medical Center all of the essential elements of an integrated at- 
 tack on the different aspects of malignancy. 
 
 The construction by the City of New York of a cancer hospital at the 
 south property began in 1940 and was carried forward after the war. This 
 development was in response to the urgent need of substantial expansion 
 of the research facilities in cancer. Active debate was carried on as to 
 whether research laboratories for this field of investigation should be 
 erected alongside, or made a part of, the cancer hospital, or be developed 
 as an extension of the basic science departments of the Medical School 
 proper in close juxtaposition to the clinical divisions of the other institu- 
 tions at the Medical Center. 
 
 The faculty reached the conviction that fundamental research in can- 
 cer in the long run holds the highest promise if closely correlated with 
 the basic medical sciences from which investigators in the future will de- 
 rive stimulation and the most recent knowledge of developments in 
 those sciences, in contrast with the creation of a separate, detached group 
 in some isolated building, even though closely associated with a cancer 
 hospital. It was this line of reasoning which led to the development of 
 
6o Continuing Self- Appraisal 
 
 the cancer research program in close and immediate cooperation with 
 the major divisions of the school. Hence, it was decided that efforts should 
 be made to obtain a unit for cancer research laboratories, the site of 
 which was to the east of the present Medical School building and on top 
 of the present Vanderbilt Clinic and School of Dental and Oral Surgery. 
 
 The laboratories of pediatrics in Babies Hospital from the beginning 
 had been seriously cramped. This was a handicap in the development of 
 a Department of Pediatrics and the school as a whole. The suggestion 
 that these be placed in the school was opposed, partly because such facili- 
 ties would not be convenient to the wards of the Babies Hospital, a type 
 of close cooperation which was essential for clinical investigation. It was 
 suggested that a modest unit be added south of Babies Hospital, in close 
 proximity to the wards of that institution and of maximum convenience 
 to the staff. 
 
 Another urgent need that was developing through the expansion of the 
 programs of the Medical Center was that of the animal quarters. From 
 the very beginning the provisions for this purpose were inadequate as re- 
 search activities and teaching became more and more dependent upon 
 animal experimentation. The handicap of inadequate facilities became 
 more clearly recognized as the postwar volume and financial support for 
 experimental work increased. 
 
 The Medical Library had become one of the most important tools of 
 medical education and research not only for undergraduate students in 
 medicine, nursing, and dentistry but for members of the teaching staff. 
 Mention was made earlier of the great increase in the utilization of the 
 library in its cramped quarters. 
 
 One of the serious defects in the original planning of the Medical 
 Center, and one which could not have been fully visualized, related to 
 the fields of public health. This area includes medical administration, 
 hospital administration, tropical diseases, vital statistics, epidemiology, 
 sanitary science, industrial medicine, medical sociology, prepayment hos- 
 pital and medical care plans, and a wide variety of other associated activi- 
 ties that serve to apply modern medical and scientific knowledge to the 
 health needs of the community and the population as a whole. These 
 facilities were greatly overloaded. 
 
 Mention was made earlier of the cooperative plan with the city of 
 
Continuing Self- Appraisal 61 
 
 New York and was partly satisfied by the opening of the Washington 
 Heights Health and Teaching Center in 1940. This later turned out to 
 be quite inadequate for the rapidly expanding program of the School of 
 Public Health. 
 
 Great impetus was given following the war to the problems of rehabili- 
 tation and physical medicine. This phase of patient care and educational 
 needs had not been widely appreciated and was pressing for immediate 
 exploration and development. This area includes, among other things, 
 cooperation with social service activities, vocational training and guid- 
 ance, industry, the reeducation of handicapped individuals, and other 
 public responsibilities. The affiliation between the University and the 
 outstanding Institute for the Crippled and Disabled was an important 
 forward movement in this field, and it was being developed jointly be- 
 tween the two institutions. That effort became effective in 1947. 
 
 The decision in 1947 to move the New York Orthopaedic Dispensary 
 and Hospital introduced a whole series of problems, because of the neces- 
 sity of converting certain floors in Presbyterian Hospital and Babies Hos- 
 pital into orthopedic wards and expanding Vanderbilt Clinic to handle 
 the necessary outpatient services. The plan for such a move was finally 
 consummated in 1950. 
 
 The contemplated expansion of Vanderbilt Clinic to house the ortho- 
 pedic program introduced other requests for larger clinics in order to 
 meet the teaching responsibilities of the outpatient services and to pro- 
 vide for the growing demands from the community for medical care, 
 preventive medicine, health examinations, group clinic, and other fea- 
 tures of health care. It was found that Vanderbilt Clinic was badly over- 
 crowded and lacked the necessary teaching units which are required in 
 a modern university clinic. There was active discussion again of the pos- 
 sibility of setting up a group practice program for insured employees in 
 the community. 
 
 A serious difficulty at the Medical Center is the absence of an audi- 
 torium to accommodate a large part, at least, of the student body and 
 which on other occasions might serve for professional meetings and public 
 assemblages. Tentative plans were begun for such a unit as part of a pro- 
 posed library-laboratory-auditorium mentioned in an earlier review. The 
 needs of all three functions were fully recognized by the faculty. 
 
62 Continuing Self- Appraisal 
 
 The idea of expanding the Vanderbilt Clinic to Broadway included the 
 possibility of making available certain additional space for the School of 
 Dental and Oral Surgery. The program for undergraduate and particu- 
 larly for postgraduate dental teaching continued to be seriously handi- 
 capped. 
 
 The problems of financial support of postgraduate training were being 
 met, particularly from the W. K. Kellogg Foundation and the benefits 
 of the Veterans Vocational Rehabilitation Act (Public Law 16) and the 
 Servicemen's Readjustment Act of 1944 (Public Law )346. 
 
 Dr. A. Benson Cannon was appointed professor of dermatology and 
 executive officer of the department to succeed Dr. J. Gardner Hopkins 
 who retired on June 30, 1947. Dr. Edmund P. Fowler, Jr. was appointed 
 professor of otolaryngology and executive officer of the department on 
 July 1, 1947, to succeed Dr. John D. Kernan who had retired. Dr. Robert 
 F. Loeb was appointed Bard Professor of Medicine and executive officer 
 of the department to succeed Dr. Walter W. Palmer who retired on 
 June 30, 1947. Professor Harold W. Brown was appointed acting associate 
 dean (Public Health), acting executive officer and director of the School 
 of Public Health on November 1, 1947. 
 
The Future of the Medical Center 
 
 In 1948 the Committee on Administration undertook another study and 
 published a report, "The Future of the Columbia-Presbyterian Medical 
 Center." The statement placed renewed emphasis upon "the education 
 of physicians, dentists, nurses, public health officers, and other profes- 
 sional personnel at the undergraduate, graduate, and postgraduate levels; 
 to the advancement of knowledge in the medical sciences and in the 
 clinical and social fields of medicine; to the diagnosis, care and treatment 
 of patients; and to the training of teachers and investigators in the med- 
 ical sciences, clinical medicine, and community medical service." The 
 report discussed: 
 
 1. The educational program. 
 
 (Significant changes have included expansion of intensive clerkships; 
 reduction in lecturing; emphasis on learning by the student and the de- 
 velopment of his intellectual powers, as distinguished from teaching by 
 the staff; improvement of correlation clinics; greater recognition of the 
 economic and psychological aspects of illness; presentation of basic sci- 
 ences in the clinical years; development of the Group Clinic; extension 
 of scheduled teaching program in the third and fourth years to twelve 
 calendar months; and the strengthening of instructional programs in 
 affiliated hospitals.) 
 
 2. The shortage of teaching beds in 
 a. Medicine. 
 
 (The hospital facilities in medicine at the Medical Center repre- 
 sent the bottleneck of the undergraduate instructional program. 
 It has been found necessary and advantageous to supplement the 
 teaching through use of municipal and voluntary hospitals to 
 provide instruction in chronic and acute diseases not adequately 
 represented in the wards of the Medical Center. About one-half 
 
64 The Future of the Medical Center 
 
 of the fourth year teaching of medical students is done in affili- 
 ated institutions.) 
 
 b. Dermatology. 
 
 (A small Dermatology Service was created in 1955.) 
 
 c. Infectious diseases. 
 
 (This has been partly solved by arrangements made at Bellevue 
 Hospital.) 
 
 3. The inadequacies in dentistry. 
 
 4. The need for more research laboratories. 
 
 (Pressure continues for expansion of facilities in several departments 
 in the school, notably Pediatrics, Pharmacology, Biochemistry, Neurol- 
 ogy, Radiology, Neurological Surgery, Anesthesiology, Public Health, 
 Dentistry, Urology, and Medicine. The increasing availability of money 
 for support of research from non-University sources has caused the short- 
 age of laboratory space, rather than of funds, to be the limiting factor in 
 development of the Medical Center's investigative programs. The need 
 for more facilities in certain departments constitutes a handicap to the 
 appointment of a staff with properly balanced interests in research, 
 teaching, and patient care.) 
 
 5. The need for expansion and modernization of the animal quarters. 
 (After many efforts over the years, plans were finally consummated 
 
 and funds were obtained to renovate, modernize and expand the facilities 
 on the seventeenth, eighteenth, and nineteenth floors of the Medical 
 School, completion of which is due in June, 1958.) 
 
 6. The dependence on affiliated hospitals. 
 
 (The clinical facilities of the Medical Center are not sufficient or com- 
 plete in certain respects. Hence it is necessary for the University to use 
 affiliated hospitals to supplement the instruction of medical students and 
 to carry an outside instructional staff, particularly in relation to chest 
 diseases, chronic diseases, rural medical practice, ambulance services, and 
 the general medical and research services in several leading hospitals in 
 New York upon which about one-half of the instruction in the fourth 
 year is dependent.) 
 
The Future of the Medical Center 65 
 
 7. The urgent library situation. 
 
 (This remains as a serious lack in the over-all Medical Center program 
 since the library is used almost as much by the hospital groups as by those 
 in the Medical School.) 
 
 8. The need for an auditorium. 
 
 (This is coupled with the library in the planning. Its construction like- 
 wise awaits additional funds.) 
 
 9. The need for a 200-bed, private-patient unit. 
 
 (The need in this situation has been partially met by expansion of 
 Harkness Pavilion, particularly on the seventh and eleventh floors in 
 1 95 1. The rapid growth of prepayment hospital and medical insurance 
 has increased the pressure for semiprivate patient facilities of all types. 
 This has introduced a major problem of keeping the Medical Center in 
 proper balance, particularly in relation to questions arising out of the 
 handling of professional fees from private patients and from those covered 
 by the various insurance plans.) 
 
 10. Apartment facilities for staff and married students. 
 
 (Little has been done in this direction. When Bard Hall was built in 
 1 93 1, consideration was given to the possible expansion of that unit for 
 married students. Bard Hall had included a limited number of tutorial 
 suites but these were not found to be practical.) 
 
 11. A department of social medicine. 
 
 (The development of the Institute of Administrative Medicine in 1950 
 and the change in the School of Public Health to the School of Public 
 Health and Administrative Medicine in 1955 partially answered this 
 question. Further integration of the Department of Psychiatry and the 
 creation of a Psychiatric Service in Presbyterian Hospital and more re- 
 cently the question of unifying the residency training between Presby- 
 terian Hospital and the New York State Psychiatric Institute are impor- 
 tant moves in this direction.) 
 
 12. Public health facilities. 
 (Discussed earlier.) 
 
 13. The development of "Institutes." 
 
 (The Institute for Cancer Research, the Institute of Comparative 
 
66 The Future of the Medical Center 
 
 Medicine, the Institute of Nutrition Sciences, the Institute for Research 
 in Mental Retardation and the Sloane Institute for Research in Human 
 Reproduction have been set up.) 
 
 14. A division of biophysics. 
 
 (The assignment of the eleventh floor of the new Institute of Cancer 
 Research to this field of study and the grouping of electrophoresis ap- 
 paratus, electron microscope, ultra-centrifuge and other developments in 
 several of the basic science departments, such as Microbiology, Anatomy, 
 and Physiology, and the expansion of electronic and other modern equip- 
 ment in other departments have met this situation reasonably well.) 
 
 15. Extension of outpatient services. 
 
 (This was done to some extent in 1951 when the tenth floor of Vander- 
 bilt Clinic was added. The net gain of space was helpful but the present 
 facilities are still inadequate.) 
 
 16. The role of properly balanced private practice offices. 
 
 (This is a matter of active study by the Committee on the Staffing of 
 the Columbia-Presbyterian Medical Center which made its report in 
 1956. This committee has continued to explore and guide this important 
 feature of the Medical Center.) 
 
 17. The Special Hospital in the Medical Center. 
 (No new developments.) 
 
 Dr. H. Houston Merritt was appointed professor of neurology and 
 executive officer of the Department of Neurology on July 1, 1948, to suc- 
 ceed Dr. Tracy Putnam. 
 
Applications 
 849 
 
 Acceptances 
 
 4 1 
 
 327 
 
 11 
 
 1,470 
 
 65 
 
 107 
 
 3 
 
 2,753 
 
 120 
 
 77z£ Medical Center At Mid-Century 
 
 There were nearly 2,800 applicants considered for admission to the first 
 year class in 1949. They had obtained their college preparation in 339 
 colleges. The 120 students accepted came from forty-seven colleges and 
 from twenty-seven different states. About one-third were residents of 
 New York City. The wide distribution of applicants was illustrated in 
 the following figures: 
 
 New York City 
 
 New York State (exclusive of New York City 
 
 Other states or territories 
 
 Foreign (outside continental United States) 
 
 Not a single student in any of the four years of the medical course failed 
 in academic work during the year. This was the first time in the history 
 of the school that such a record was established. It was a tribute to the 
 high quality of the students accepted, their diligence and sustained ef- 
 forts, and the intensive program of instruction. It also reflected the 
 ability and hard work of the Committee on Admissions, of which Associ- 
 ate Dean Aura E. Severinghaus was chairman. 
 
 The prospect of additional laboratories in cancer research discussed 
 earlier was realized by a grant from the United States Public Health 
 Service of $1,000,000 which was matched by the University. Plans for 
 the laboratories were completed, contracts let, and construction begun 
 in 1949. 
 
 Dean Rappleye was appointed vice-president in charge of medical af- 
 fairs. Dr. Maurice J. Hickey was appointed associate dean (Dental and 
 Oral Surgery) and executive officer of the department on October 1, 
 1949, to succeed Dr. Bion R. East. Dr. J. Lawrence Pool was appointed 
 professor of neurological surgery and executive officer of the newly 
 created department on January 1, 1949. 
 
68 The Medical Center at Mid-Century 
 
 The University initiated its retirement plan in 1950 for nonacademic 
 employees as an important fringe benefit. The graduate and postgraduate 
 programs described earlier were carried forward. The Institute of Cancer 
 Research created in 1949 integrated the numerous activities at the Med- 
 ical Center in the new cancer research laboratories and the Francis Dela- 
 field Hospital. The generous support of the American Cancer Society, 
 the National Cancer Institute, the University, and many gifts and con- 
 tributions launched this program with great promise. Four floors of re- 
 search laboratories will prove to be an enormous asset to the whole insti- 
 tution. 
 
 The University staff took an active part in the development of the 
 Health Maintenance Demonstration at Montefiore Hospital, initiated by 
 the Community Service Society of New York working in collaboration 
 with the Health Insurance Plan of Greater New York. This program 
 represented an opportunity for the University to apply its general phi- 
 losophy of medical education and community service. 
 
 The Sloane Institute for Research in Human Reproduction was estab- 
 lished under the Department of Obstetrics and Gynecology in 1950. The 
 purpose of the Institute was to further the study of human reproduction, 
 recognizing that the task of providing safe motherhood and securing a 
 normal and healthy child is one of the great challenges to the medical 
 profession. 
 
 During 1950 a plan was worked out for the exchange of residents from 
 Presbyterian Hospital with the registrars from Guy's Hospital in London, 
 England, financed jointly by Guy's Hospital and the Josiah Macy, Jr., 
 Foundation. The program represented an important type of international 
 cooperation. 
 
 During the year the City of New York, acting upon the recommenda- 
 tion of Mayor William O'Dwyer, extended for another five years the 
 agreement for the construction of the Public Health Center on Riverside 
 Drive between 165th and 168th Streets. It was planned that the institu- 
 tion would include the laboratories of the New York City Department 
 of Health, those of the Public Health Research Institute, Incorporated, 
 and the School of Public Health of the University. As mentioned earlier, 
 the contract expired in 1955 and was not renewed again. 
 
 The city also created the new Board of Hospitals for the city of New 
 
The Medical Center at Mid-Century 69 
 
 York to serve as the top policy-making body of the Department of Hos- 
 pitals. The board has the duty of developing long-term programs for the 
 care of the aged, sick, and infirm of the city and to permit the highest 
 possible standards of medical care in the municipal institutions. This de- 
 velopment was of considerable interest to the teaching institutions of the 
 city. The Dean was appointed one of the original members of the new 
 board. 
 
 Renewed attention was being given in the country and in the faculty 
 to "premedical" education. There seemed to be general agreement in the 
 thinking of our own Committee on Admissions that students should be 
 selected for professional education not so much on scholastic grades, 
 aptitude tests, or the subjects which they have taken in college as upon 
 their character, personality, evidence of intelligence, ability, industry, 
 general culture, resourcefulness, maturity, and evidence of grasp of the 
 principles underlying the sciences upon which medical study is depend- 
 ent. Only through properly trained and competent personnel able to 
 keep abreast of newer developments in the future can the community 
 expect to meet its responsibilities for the care and treatment of illness 
 and the preservation of health. There is no substitute for this essential 
 feature. 
 
 Dr. John B. Truslow, assistant dean in charge of graduate studies re- 
 signed on December 31, 1950 to become dean of the Medical College of 
 Virginia. Miss Margaret E. Conrad, who had been appointed professor 
 of nursing on November 1, 1935, and executive officer of the department 
 on July 1, 1937, and associate dean (Nursing) on July n, 1945, and who 
 also was director of the Nursing Service in the hospital from November, 
 1942, resigned on December 31, 1950. Miss Eleanor Lee, assistant pro- 
 fessor of nursing was appointed on January 1, 1951, as acting executive 
 officer of the department in the University. 
 
 In 1 95 1 the University initiated its participation in the Federal Social 
 Security plan on a voluntary basis. Participation was made a condition of 
 employment for all new employees and academic appointees in the future. 
 
 The University was inaugurating its development program at the 
 Medical Center in an effort to mobilize interest and support from alumni, 
 foundations, community organizations, and the public. The National 
 Fund for Medical Education, Incorporated, organized in 1949, was be- 
 
yo The Medical Center at Mid- Century 
 
 ginning its efforts, and the Commission on Financing Higher Education 
 had issued its report involving medical education. These and other en- 
 deavors recognized that the whole problem of financing medical educa- 
 tion would have to be attacked vigorously, realistically, and promptly if 
 the country was to retain the high standard developed during the last 
 four decades. It seemed clear that the challenge could be met only by a 
 multilateral attempt at financing the considerable needs of this phase of 
 higher education, in addition to the valuable and essential contributions 
 being made by the professional staffs of the medical schools who are 
 rendering substantial professional and public services with little or no 
 compensation from the hospitals associated with the school. Another 
 method suggested for assistance in this problem was by utilization of the 
 earnings of the full-time or geographical full-time professional staff for 
 work incidental to their responsibility in the teaching hospitals and 
 school. There was confidence in the propriety of charges for professional 
 services rendered by the residents of the hospitals for patients covered 
 by prepayment medical care insurance. It was clearly understood by the 
 faculty that support from professional fees should not be allowed to grow 
 to the point of interfering with the primary duties and responsibilities 
 of the clinical staff. 
 
 Attacks by organized medicine were developing in various parts of 
 the country. Some were leveled at the institutions here, particularly 
 those who employed physicians on a salary basis and whose professional 
 fees were retained by the hospital. A proper balance in this economic area 
 would have to be preserved between the staff of the Medical School and 
 the practicing profession. As long as the purpose of the University group 
 is education and research, as distinguished from private practice, and as 
 long as the income from such a source would be used only to support 
 these educational and research activities, there should be no real difficul- 
 ties. Leaders of the profession are fully aware of the essential contribu- 
 tions made by these individuals to the training of future physicians. 
 
 There was again active discussion of the cost of medical education 
 which is probably not as great as many believe and some reports have 
 stated. What is often overlooked is that the medical schools are rendering 
 educational opportunities to large groups of different students and are 
 conducting many services and research programs of public benefit which 
 
The Medical Center at Mid- Century 71 
 
 should not be chargeable against the teaching of medical students per se. 
 Our faculty provides instruction for over one thousand full-time medical, 
 dental, public health, nursing, occupational therapy, physical therapy, 
 dental hygiene, graduate students from the Faculty of Pure Science, and 
 visiting scholars and fellows; for more than two hundred members of the 
 house staff of the hospitals at the Medical Center; and continuing edu- 
 cational contributions to the advancement and development of the 
 younger members of the attending staff. The research activities represent 
 a substantial fraction of the total work done by the staff and hence of the 
 University budget assigned to the Medical School. It is recognized that 
 the responsibilities of the clinical departments for the care and treatment 
 of patients in the wards and clinics of the hospitals, necessary for the edu- 
 cation of students, should not be fully charged to the cost of that in- 
 struction. 
 
 Plans were begun for consolidating more active support from the 
 alumni of the school. Also there was more active discussion in regard to 
 support of medical education from federal sources. In view of the fact 
 that graduates of the Medical School are expected to join the armed 
 services and that many of them ultimately settle in other parts of the 
 country and, hence, help to meet the health needs of the nation in civil- 
 ian capacities, it would seem proper in the national interest that some 
 support could be obtained from government sources. This could be looked 
 upon as a reimbursement to the University for the professional manpower 
 needs of the country as well as to the advancement of knowledge in the 
 diagnosis, treatment, and prevention of disease. 
 
 Everyone is in agreement that the amount of such support should be 
 modest and safeguarded to avoid any possible threat to control of the 
 program of the University by the national government, a danger that is 
 greatly exaggerated. In the sometimes vigorous and emotional criticisms 
 of possible federal assistance to medical education, there is a tendency to 
 overlook the fact that the attacks are being made on our own govern- 
 ment, with which the profession, the universities, and the medical schools 
 should be expected to cooperate in order most effectively to carry out 
 the programs for which they exist in society. Adequate safeguards can be 
 built into a plan of such needed assistance in the over-all national needs. 
 
 Active debate has arisen during the postwar period about the future 
 
72 The Medical Center at Mid- Century 
 
 supply of doctors for the country. Some have predicted a dire shortage 
 of physicians by 1960-1970. Great pressure has been put on the medical 
 schools substantially to increase their enrollment to meet the crisis which 
 some have predicted, often without due consideration of the elements 
 and essential steps necessary to preserve quality of teaching and later of 
 practice. These attacks have come from political sources, colleges, news- 
 papers, and others. There is a shortage in certain areas of the country, 
 largely through maldistribution of physicians and a lack of sufficient 
 numbers of qualified persons in some of the newer special phases of edu- 
 cation and practice such as psychiatry, pediatrics, rehabilitation, anes- 
 thesiology, radiology, laboratory staffs, teachers, and investigators. It is 
 important in any discussion about the production of physicians to link 
 such proposals with methods for their proper utilization in relation to 
 the actual health needs of the country. What this nation requires is 
 better doctors before it needs more. 
 
 The whole field of medical security is growing in prominence in the 
 thinking of labor leaders, industrial and government officials, and the 
 profession. It is becoming increasingly apparent that the American people 
 are convinced of the value of competent health services and sooner or 
 later will determine that in some way the benefits of modern medicine 
 will be made available to all. This is based on the philosophy that ade- 
 quate medical care is intended for the people of the country and not for 
 the benefit of the profession. In that public responsibility, safeguarding 
 the best interests of the profession and retaining the competent physician 
 of high quality must be built into any proposal. 
 
 In response to some of these considerations, the faculty recommended 
 and the Trustees approved the creation of the Institute of Administra- 
 tive Medicine in 1950. It represented an effort on the part of the whole 
 institution to evaluate, study and appraise many features of community, 
 hospital and professional organization to meet the growing demands of 
 the American public. This is illustrated in part by the divisions set up 
 under the Institute for 
 
 1 . Hospital administration 
 
 2. Prepayment medical care 
 
 3. Public health administration 
 
 4. Industrial medicine 
 
 5. Medical school administration 
 
The Medical Center at Mid- Century 73 
 
 Too little attention has been paid in recent years to the impact upon 
 the staffs of the medical school by the numerous social, economic, and 
 professional developments. Emoluments and financial rewards offered 
 by industrial concerns are making serious inroads into the recruitment 
 of physicians and teachers. Lately the government has entered this com- 
 petition for the limited supply of men through its numerous, expanding 
 activities which offer many inducements, including liberal pensions and 
 social security, which can be met only partially by the universities. This 
 is a part of the over-all financial dilemma of the medical schools and 
 indicates a clear and pressing danger to the future of professional educa- 
 tion. 
 
 The role to be played by private-practice income and fees from pro- 
 fessional services rendered to insured patients enters into this considera- 
 tion as well. The growing inflation now quite evident only adds to the 
 disparity between the financial return to the academic instructor and the 
 opportunities in other areas, particularly private practice. Already signs 
 are appearing in various places in the country indicating the shift of the 
 center of gravity in medical centers toward private practice and toward 
 hospital control in view of the inability of most universities adequately 
 to support or to secure additional financial aid for the medical school pro- 
 gram. The effect of this has been notable particularly in the basic science 
 departments since many well-trained physicians who formally went into 
 those divisions now are attracted to the clinical departments or oppor- 
 tunities associated with them. The result is the depletion of men in the 
 basic sciences who have had medical training. This explains the fact that 
 there are many full-time positions in the basic sciences throughout the 
 country which are unfilled. 
 
 This trend will have an important effect on the future of medical edu- 
 cation because it is from the underlying sciences that the fundamental 
 contributions will be made, and in which leaders must be developed, if 
 we are to continue progress in the clinical application of these sciences in 
 industrial hygiene, public health, and professional practice itself. Too 
 little attention has been paid to this serious threat to medical education. 
 
 The inauguration of the Institute of Cancer Research in 1951, referred 
 to earlier, brought to fruition this important feature of the Medical 
 Center program. 
 
 Professor Harold W. Brown was appointed associate dean (Public 
 
74 The Medical Center at Mid- Century 
 
 Health) and director of the School of Public Health on January i, 1951 
 to succeed Dr. Harry S. Mustard. Dr. Carl T. Nelson was appointed pro- 
 fessor of dermatology and executive officer of the Department of Derma- 
 tology on July 1, 1951, to succeed Dr. A. Benson Cannon, who died in 
 November, 1950. Dr. James E. McCormack was appointed associate dean 
 (Graduate Studies) on September 1, 1951. 
 
 Numerous renovations and improvements in Presbyterian Hospital 
 were completed in 1952. The expansion in private offices and private 
 room facilities permitted further extension of the geographical full-time 
 system. The integration of the program of the Francis Delafield Hospital 
 with the other activities at the Medical Center went forward actively. 
 
 The Department of Anesthesiology was created as an independent 
 division in 1952. Dr. Emanuel M. Papper was appointed as professor of 
 anesthesiology and executive officer of the department on January 1. The 
 new Department of Physical Medicine and Rehabilitation was launched 
 through the generous support of Mr. Bernard Baruch. Dr. Robert C. 
 Darling was appointed professor of physical medicine and rehabilitation 
 and executive officer of the new department. The name of the Depart- 
 ment of Bacteriology was changed to the Department of Microbiology. 
 The new Institute of Research in Animal Diseases (later designated the 
 Institute of Comparative Medicine) was set up and gave recognition and 
 impetus to an area of study which had been developing at the Medical 
 Center for many years. 
 
 Dr. Alfred Gellhorn was appointed director of the newly created Insti- 
 tute of Cancer Research. Dr. Harry M. Rose was appointed John E. 
 Borne Professor of Medical and Surgical Research and executive officer 
 of the Department of Microbiology on July 1, 1952, to succeed Dr. 
 Dochez. 
 
The Twenty-Fifth Anniversary 
 of the Columbia-Presbyterian Medical Center 
 
 One of the most important events of the academic year was the celebra- 
 tion on October 12 and 13, 1953, of the twenty-fifth anniversary of the 
 opening of the Medical Center. The past quarter of a century had 
 demonstrated the wisdom of the Hospital and the University in creating 
 a real center of medical teaching and research which, as promised, has 
 provided the highest quality of patient care, community service, medical 
 education, and research. 
 
 The affiliation of Columbia University with the Presbyterian Hospital 
 and other institutions at the Medical Center, when it was put into effect 
 twenty-five years earlier, represented a fresh concept which attracted the 
 generous support of farsighted benefactors. It paved the way for the sig- 
 nal advances which the Medical Center has made in the training of lead- 
 ers of medical thought, in the techniques and policies of medical educa- 
 tion, in the store of knowledge of human biology, and in services to the 
 community and the nation. 
 
 It has been dedicated to the endeavor to create an environment in 
 which medicine of the highest scientific standards can be attained. The 
 emphasis has been upon men and not upon bricks and mortar. The ideal 
 of the Medical Center is to give further impetus to the development of 
 medical knowledge, which during the last fifty years has been more note- 
 worthy than in the previous four thousand. Medicine today is on the 
 threshold of unprecedented developments. 
 
 The faculty and staff of the Medical Center have contributed materi- 
 ally to the sound evolution of medical education through the continued 
 emphasis upon scientific medicine, which must remain the basis of prac- 
 tice in the future; to which is added the interpretation of social, psycho- 
 logical, emotional, and economic factors in the care, treatment, and study 
 of patients. The teaching programs of the University in the undergrad- 
 uate, and postgraduate training of physicians have never lost sight of the 
 
j6 Twenty-Fifth Anniversary 
 
 patient as the unit of medical care. Contributions to these broad con- 
 cepts include the creation of the social service department, perhaps the 
 first of its kind in this country. The follow-up clinics and the unit history 
 system were established in recognition of the "longitudinal" study of 
 patients as distinguished from the purely cross-section method of obser- 
 vation, so common in teaching clinics elsewhere. The newer methods of 
 case study of individual patients have given fresh meaning to the term 
 "preventive medicine" because they are applicable to every type of ill- 
 ness. They bring significance to conditions of employment, the home en- 
 vironment, family problems, conditions of housing, the economic factors, 
 and emotional impacts which so often determine aspects of sickness and 
 disability. 
 
 The study of stress as a factor in health and disease and the develop- 
 ment of the "personality panel" indicate the early recognition by the 
 faculty of these important concepts. The introduction of psychiatric 
 teaching on all of the wards in the hospitals and in student clerkships 
 points clearly to an endeavor to understand the total individual and the 
 relationships between psychological and emotional factors and their in- 
 fluence on bodily function. 
 
 The philosophy in the educational program has been shifted from the 
 earlier ideas of teaching by the faculty to learning by the student, be- 
 cause anything worth knowing can not be taught, it must be learned. 
 This defines the medical course itself only as the foundation for the neces- 
 sary continuous self-education of the successful physician throughout his 
 professional career. The concept regards the four-year medical course as 
 a unit, rather than as a series of isolated subjects, by integrating the basic 
 sciences and clinical disciplines through correlation and combined clinics 
 and other instructional devices. The program emphasizes instruction in 
 group and rural medical practice, leadership in the fields of graduate and 
 postgraduate medical education, new developments in administrative 
 medicine, the role of the basic medical sciences in sound clinical teaching 
 and practice, the importance of the chronic diseases, preventive medicine, 
 psychiatry, psychosomatic medicine, the handling of emergencies, the 
 development of the full-time system of university teaching and research, 
 and concentration at the Medical Center of a large proportion of the 
 staff on the geographic full-time system, as illustrations. 
 
Twenty-Fifth Anniversary 77 
 
 The impressive contributions to medical science can be well illustrated 
 by a few examples, such as those on the pituitary gland and its hormonal 
 interrelations, the pioneer studies of isotopes in intermediary metabolism 
 of a variety of physiologic substances, the discovery of the structural 
 formula of vitamin B 1? the development of quantitative immunochem- 
 istry, experimental studies of muscular dystrophies, the chemistry of 
 blood group substances and the role of blood volume in shock, the porta- 
 caval shunt in the treatment of cirrhosis of the liver and other advances 
 in cardiac and blood vessel surgery, successful resection of the head of the 
 pancreas for cancer, discovery of bacitracin, studies in the diagnosis and 
 treatment of adrenal tumors, iodine uptake in thyroid carcinoma, defini- 
 tion of electrolyte disturbances in Addison's disease, the role of strepto- 
 coccal infection in scarlet fever and rheumatic fever, the dietary treat- 
 ment of cirrhosis of the liver, the physiology of heart disorders and the 
 introduction of cardiac catheterization, demonstration of viral etiology 
 of the common cold, first clinical use of penicillin in the United States, 
 the cephalin flocculation reaction, discovery of acid phosphatase in the 
 blood and its use in the diagnosis of cancer of the prostate, the first 
 clinical use of vitamin B 12 , introduction of helium-oxygen mixtures for 
 obstructed breathing, serologic methods for the diagnosis of rheumatoid 
 arthritis, chemical recognition of pheochromocytoma and the role of 
 nor-epinephrine, contributions in electrophoresis, the chemistry of the 
 cell nucleus, the isolation of the milk factor in breast cancer in mice, 
 pioneer studies of circulation with radioactive sodium, the measurement 
 of radiation dosages, research in the understanding and control of bleed- 
 ing, advances in anesthesiology, the control of influenza meningitis, the 
 character and behavior of bacterial genes, the value of chloroquine as a 
 curative agent in amebic abscess of the liver, the discovery of the only 
 known chemical test for cancer-acid phosphates in cancer of the prostate, 
 demonstration of control by the adrenal gland of salt and water excretion 
 in the kidney, studies in man of cardiac and pulmonary physiology, 
 pioneer studies on the splanchnic circulation in man, demonstration of 
 basic anti-inflammatory effects of cortisone and other steroids on tissues, 
 development of protection against infection in liver disorders, introduc- 
 tion of the nutritious diet for the present-day management of cirrhosis of 
 the liver, demonstration of the control of pernicious anemia with vitamin 
 
78 Twenty-Fifth Anniversary 
 
 B 12 , pioneer studies on the chemical nature of connective tissue in health 
 and disease and the anoxemic test for coronary artery insufficiency. 
 
 Using the Medical Center as a base of operation the University has 
 worked out numerous affiliations with other hospitals, health depart- 
 ments, and industry; prepayment insurance plans; home care services; 
 and a wide variety of community activities designed to strengthen the 
 health and professional services for the entire New York area. It has 
 made noteworthy contributions in the continued education of physicians 
 and in the residency training in a number of affiliated hospitals, and has 
 constantly striven toward maintenance of high standards of medical 
 practice in the country. 
 
 Fully aware of the many and diverse responsibilities which revolve 
 about the health services in the community and the nation which the 
 several professions must carry, the University has rendered its most im- 
 portant and broadest public service through the maintenance of a high 
 level of professional education in the health sciences and concentration 
 upon the primary purpose of real education, — the stimulation and en- 
 couragement of first-class minds and intellectual effort. It can and should 
 carry its share of the obligation for hospital services, the continued train- 
 ing of practitioners, and the preparation of specialists. Its greatest con- 
 tribution, however, is to educate men and women to meet these responsi- 
 bilities, rather than to assume direct management of community services, 
 except those necessary to discharge its function. 
 
 The Medical Center reflects the changing responsibilities of medicine 
 in a progressive society. It has mirrored the development of medicine 
 from an empirical art to the application of scientific methods to the diag- 
 nosis, treatment, and prevention of sickness and disability, without losing 
 the deep humanistic values which have set medicine apart from most 
 other callings. 
 
New Challenges 
 
 While every effort has been made to retain as fully as possible the level 
 of medical education and practice developed during the last forty years, 
 a new feature has entered into the struggle to maintain standards for the 
 country. A large number of physicians are seeking admission from foreign 
 countries. About one-seventh of the internships and residencies of the 
 hospitals in the United States are filled by aliens. The ratio is rising. 
 About one-half of all of the internships and residencies in New York is 
 occupied by aliens. There is no reflection whatsoever upon the indi- 
 viduals or their efforts to obtain a professional status or education. How- 
 ever, a great many are from countries which do not provide the quality 
 of instruction regarded in the United States as adequate. This situation 
 represents a new phenomenon in American medicine which has a direct 
 bearing on the standards of medical practice throughout the country. 
 
 The state of New York in 1953, through the Brydges Act, permitted 
 all hospitals to appoint interns without regard to their educational quali- 
 fications and many hospitals to appoint residents under the same condi- 
 tions. The state obviously intended to solve the problems by abdicating 
 essential standards adopted and enforced in the past. Some of the ex- 
 travagant and dire predictions of the advocates of legal recognition of 
 lower standards merely reflected their unwillingness or inability to come 
 to grips with this vital question. While not directly involving the Med- 
 ical Center the over-all problem was of concern to everyone interested in 
 the maintenance of a proper level of medical practice. Those responsible 
 for the legislation in New York contend that the standards were not 
 lowered. It is evident that they were not reduced but merely eliminated. 
 
 The program of research in chronic diseases identified especially with 
 the Goldwater Memorial Hospital begun in 1936-37 had been going for- 
 ward with financial support from the Public Health Research Institute, 
 the Josiah Macy, Jr., Foundation, and grants from the United States 
 Public Health Service. The unit established on Welfare Island had been 
 making notable contributions in the field. In 1954 the plan was further 
 
8o New Challenges 
 
 stabilized by an agreement with the city of New York* which provided 
 for some financial aid from the city in carrying out the responsibilities 
 of the University at that institution. 
 
 Dr. Lawrence C. Kolb was appointed professor of psychiatry and ex- 
 ecutive officer of the department on July i, 1954, to succeed Dr. Nolan 
 D. C. Lewis, who had resigned. Mr. Alvin J. Binkert was appointed vice 
 president and general manager of Presbyterian Hospital in 1954 to suc- 
 ceed Mr. John S. Parke, who died in August of that year. 
 
 SOCIOECONOMIC CONSIDERATIONS 
 
 The growing economic pressure upon staffs of medical schools has been 
 reflected in attempts to modify the status of University appointees in 
 the Medical School. A number of organized efforts to improve the status 
 of University medical education might be reviewed. 
 
 The whole world is in a state of unrest and change which, even in our 
 own country, is bound to have an impact upon the health services and 
 the medical profession because the latter are essential elements of a 
 modern society. The problems must be considered in that broad context 
 and perspective. Change and evolution are inevitable. Individuals and 
 organizations must learn to adapt themselves to new conditions. Yet, in 
 spite of all of the ferment, the elements of sound professional education 
 and the dedication of the profession and hospitals to the needs of com- 
 munities and the sick are not altered in any fundamental degree. While 
 medical education is only a relatively small part of the over-all complex, 
 it is a highly significant feature because of the responsibilities for the 
 supply and education of physicians to meet the future health needs of 
 the country. Although it is not the function of the medical school directly 
 to assume community activities beyond those necessary for its own pro- 
 gram, it does have the obligation to educate and prepare men and women 
 to discharge those responsibilities. 
 
 Inasmuch as the keystone in the arch of health services is the physician, 
 the question of a sufficient supply is of significance. At the present time 
 there is one to about 750 persons. The gross ratio is approximately suf- 
 ficient if all doctors were adequately trained, better distributed, up-to- 
 date in their knowledge and skills, and more effectively used in relation 
 to actual needs. 
 
 *See Appendix I, 
 
New Challenges 81 
 
 Attention may be called to the fact that during the last forty-five years 
 the number of medical graduates has risen 117 percent while the popula- 
 tion has grown 76 percent. The output of the medical schools in recent 
 years has increased more rapidly than the population. The figures are the 
 least significant part of the picture, however, because the quality and 
 competence of doctors are far more important than their numbers. 
 
 The desire of the American public to obtain medical and hospital care 
 is well illustrated by the fact that more than 126 million persons in the 
 country have some degree of voluntary prepayment hospital and medical 
 care insurance, partly through the growth of fringe benefits attached to 
 labor union contracts. The number has increased nearly eighty millions 
 in the last ten years. This phenomenon is already having a profound im- 
 pact upon hospital and medical practice and will influence both in the 
 years ahead. It presents a great challenge to the profession because ul- 
 timately there will be legal regulation of benefits and premiums. The 
 solution will require ingenuity and imagination if the high level of health 
 care now provided for large, though not all, elements of the population 
 is to be preserved. At the same time it is important to avoid the level of 
 mediocrity which might follow any scheme of regimentation. 
 
 One illustration of the impact of current medical economics is the re- 
 duction in ward teaching services so vital in the clerkships, internships, 
 and the residency training programs as well as in research and the con- 
 tinued education of younger attending physicians in hospitals. It will be 
 necessary to make insured patients available in some satisfactory manner 
 to provide opportunities for instruction during the different stages of the 
 physician's training. The most serious difficulties will be in the curtail- 
 ment of freedom for investigation and the advanced training in the 
 residency programs for the surgical and other specialties. At Presbyterian 
 Hospital 85 percent of the charges for the care of ward patients are met 
 by the city and from the Blue Cross and other insurance plans. Only 
 about 15 percent of the ward patients at the Medical Center are now 
 responsible directly for their own bills. 
 
 There is a disposition in many places to pool the fees for insured ward 
 patients and to use the money for strengthening and promoting the edu- 
 cational activities for the house staff. This practice will require, in some 
 instances, a modification in the way carriers make payment and in the 
 attitude of the local profession. It is hoped that plans can be formulated 
 
82 New Challenges 
 
 whereby compensation may be based on the services rendered rather 
 than on fees of individual physicians because in a modern medical pro- 
 gram adequate care frequently is rendered by a group working as a team. 
 
 Corporation contributions to all private educational institutions last 
 year represented only eight cents of each dollar of expenditures on the 
 part of universities and colleges. The $100,000,000 given, while large, is 
 only a small fraction of the total national product of goods and services. 
 It was only one-fourth of one percent of net corporate profits before 
 taxes, a small investment indeed in a function essential to American so- 
 ciety and to American industry as well. One-fortieth of one percent of 
 those net profits would underwrite the present deficits of the medical 
 schools of the country. 
 
 It is also worthy of note that the entire cost of medical education in 
 the country at the present time is only about one percent of the ex- 
 penditures for all forms of health services. The net cost is only one-tenth 
 of even that. The profession, alumni, foundations, industry, the public, 
 the National Fund for Medical Education, the American Medical Edu- 
 cation Foundation, and other sources of supplementary financial support 
 are necessary to maintain the high standards and leadership in America 
 and to preserve even a few islands of high excellence. 
 
 The effects of current pressures upon the operation of medical schools 
 are of concern to all who are interested in the future of medicine. The 
 economic factors are evidenced by the number of unfilled positions on 
 teaching staffs and the drift away from academic medicine toward private 
 practice. These and other forces explain the trend toward a modernized 
 version of the "proprietary" and "hospital" medical school, now an in- 
 creasingly common pattern in the country. This is to be regretted be- 
 cause the rapid advance of teaching and investigation during the last 
 forty years has been largely due to the development of full-time research 
 and teaching opportunities in the clinical departments and the drawing 
 of well- trained young men and women into academic careers in the basic 
 medical sciences and clinical medicine. 
 
 One result of the widening interest of the public in demanding and 
 providing support through various channels for better health services has 
 been the necessity for the physicians, the profession, and the medical 
 schools to define more clearly their responsibilities to the community and 
 
New Challenges 83 
 
 to the health needs of individuals, industry, and society as a whole. Men- 
 tion need only be made of the catastrophic and chronic diseases, the 
 problems in rural areas, the needs of the aged, those with mental dis- 
 orders, the health problems in industry and schools, and the rehabilita- 
 tion of the handicapped to suggest the expanding areas of medical par- 
 ticipation in public questions. If the different organizations, such as the 
 insurance carriers, industry, the National Fund for Medical Education, 
 and the federal and state governments, are going to be called upon in 
 large measure to finance the necessary health services of the country, it 
 is inevitable that they must have a fuller understanding of the problems 
 of medical practice, service, and education. The young physician must 
 be more fully equipped and have a better appreciation of his responsi- 
 bilities and obligations in present-day society than now is so often the 
 case. 
 
 It is a challenge to the professions, institutions, industries, and govern- 
 ment to coordinate their efforts in formulating ways and means by which 
 sound, progressive programs can be provided. It would be more than un- 
 wise to ignore the broad obligations of medicine, which must be recog- 
 nized as a social as well as a biological science. It is imperative today that 
 medical instruction recognize and deal with the social, economic, emo- 
 tional, and other environmental elements in illness, health, and incapa- 
 city because the concern of the present-day physician must be with so- 
 ciety as well as with medicine, with human beings in their environment 
 and with their multitude of anxieties and emotions as well as with their 
 pathology. These considerations need not and should not substitute for a 
 thorough education in the basic disciplines, but rather should supplement 
 and vitalize it. Scientific knowledge is founded on these disciplines and 
 the future of medical progress, medical care, and public service depends 
 upon them. 
 
 CHANGES IN CLINICAL TEACHING 
 
 The reformation of medical education in this country was reviewed 
 briefly early in this report. The determination to elevate standards 
 aroused the universities, and, later, the large financial contributions made 
 possible the development of university clinical medicine in this country. 
 A number of universities had had good training programs in the clinical 
 
84 New Challenges 
 
 divisions but, except in a few instances, practically all of the instruction 
 was provided by practitioners who made their living from private prac- 
 tice. 
 
 The widening fields and complexities of medicine required a better 
 education of doctors, the training of clinical teachers, the conduct of 
 clinical research, and the direction and education of younger members of 
 the staffs of both the medical schools and the teaching hospitals. The 
 growth of teaching services on the wards of the university-affiliated hos- 
 pitals emphasized the necessity of creating and supporting university de- 
 partments of clinical medicine and surgery. 
 
 Two general plans developed. The first was a gradual increase in the 
 teaching, research, and hospital responsibilities of the clinical teachers, 
 which was reflected in the expansion of medical school and hospital 
 facilities, better compensation, the employment of full-time assistants, 
 technicians, secretaries, and other elements that go into the creation of a 
 medical school department. In the beginning, the doctor usually kept his 
 own office and retained his own private fees. Later, as duties increased 
 and individuals developed their own interests in teaching and research, 
 it was natural that their work be concentrated at the medical school and 
 teaching hospital. Here they were granted the privilege of seeing patients 
 and retaining the professional fees. 
 
 The second plan was a more complete break from practice — the setting 
 up of purely university departments of medicine and surgery. The origi- 
 nal plans of the strong advocates of this program called for a strictly full- 
 time basis of employment on a salary. The professor was not expected to 
 see private patients. Later, when that plan did not work out satisfactorily, 
 he was permitted to see private patients but not allowed to charge fees. 
 This program also did not last long — the universities found it difficult to 
 provide the salaries of the senior members of the staff and their assistants, 
 and the necessary laboratory and other expenses. Nevertheless the plan 
 served a useful purpose in that it indicated the importance of having the 
 teaching concentrated in clinical departments of universities rather than 
 conducted by practitioners who could only give secondary consideration 
 to problems of research and instruction. 
 
 The development of one form or another of university full-time medi- 
 cal teaching explains in considerable degree the great progress of Ameri- 
 
New Challenges 85 
 
 can medicine during the last forty years. The plan of university medicine 
 has been widely adopted and could be expanded a great deal further if 
 more money could be found for its support. The present inflation calls 
 for numerous modifications to provide increases in the compensation of 
 clinicians and other members of the staff — increases which the universi- 
 ties under current economic conditions cannot provide from their own 
 funds. Many such modifications of the full-time system have taken place 
 in the last few years. 
 
 The combination of strictly full-time, geographic full-time, and part- 
 time in a single institution presents some difficulties in balancing the re- 
 sponsibilities, opportunities, and financial return to members of the staff. 
 The mere coexistence of a large group of men in private practice who 
 enjoy relatively large incomes and hospital as well as University privileges 
 and a smaller group of men who are trying to develop into medical in- 
 vestigators and teachers offers a local problem which is reflected in part 
 in the influence and motivation of students as well as the younger mem- 
 bers of the organization. There is a strong tendency in such institutions 
 for the center of gravity and primary interest to shift toward private 
 practice. 
 
 The development of full-time research and teaching opportunities in 
 the clinical departments of the medical schools of this country has con- 
 tributed greatly to the rapid advance of medical teaching and research 
 during the last several decades by drawing increasing numbers of well- 
 trained young medical men and women into academic careers in the 
 clinical departments of universities. The effect has been to attract into 
 clinical departments to an appreciable extent the normal flow of young, 
 well-trained medical men who in earlier periods went into the basic sci- 
 ences, with consequent reduction at present of a supply of teachers and 
 investigators in the basic sciences who have had a medical training. A 
 balance between clinical medicine and the medical sciences can be main- 
 tained only if the incentives and attractions of the medical sciences com- 
 pare reasonably favorably with corresponding opportunities in the clini- 
 cal full-time fields. At the present time, the instructional staffs of the 
 medical sciences throughout the country are being largely recruited from 
 nonmedical personnel. 
 
 Columbia University has explored all plans from practitioner teaching, 
 
86 New Challenges 
 
 including outside tutoring classes, to the strictly full-time basis without 
 any outside private practice. The present program is a combination of all, 
 arrived at by evolution and adapted to the conditions in New York City 
 and at the Columbia-Presbyterian Medical Center. The aim is to have a 
 nucleus of strictly full-time persons as the executive officers of most of 
 the major clinical departments, a group of major, full-time assistants in 
 various stages of advanced training for academic careers, and a large num- 
 ber of geographic and part-time teachers. 
 
 RECRUITMENT OF STUDENTS 
 
 During recent years the applications for admission to medical schools 
 have been declining, due in large part to the many opportunities offered 
 to recent college graduates in industry, government service, and various 
 other activities which make it possible for a student to become eco- 
 nomically independent at a much earlier age than if he were to pursue a 
 professional education. It happens that the present expanding economy 
 of the country is demanding many more young men and women who are 
 in their early twenties. This group is being drawn from a largely reduced 
 population pool — reduced because of the low birth rate in the depression 
 years. 
 
 The prediction at the moment is that the student enrollments in the 
 years ahead will be markedly accelerated. For example, the total of pupils 
 in high school in 1950 was 6.6 million, but by 1965 it will be 12.5 million. 
 The college population of approximately 2.5 million students at the pres- 
 ent time will be close to double that number in ten years. In 1930 only 
 12 percent of the students of college age were actually in college. This 
 rose to 18 percent in 1940 and now is about 30 percent. There are those 
 who question many of the objectives of mass education; they fear that 
 education for all is in fact education for none. 
 
 As for recruitment of professional personnel, many of the large indus- 
 tries, even some related to the health programs, have themselves intro- 
 duced problems for the universities and others interested in securing an 
 adequate supply of scientists, investigators, and medical, dental, public 
 health, and other students. If this trend continues, in combination with 
 other nation-wide developments which have a similar effect, it will even- 
 tually curtail the supply of physicians, research workers, and teachers for 
 
New Challenges 87 
 
 the universities and eventually for the needs of the country. This in the 
 long run would be most unfortunate. 
 
 The situation has been recognized in recent years but as yet no sub- 
 stantial solution has been found to insure the maintenance of an adequate 
 supply for the sciences and clinical departments or to insure the recruit- 
 ment of sufficient numbers of highly qualified individuals for the health 
 services. The public campaigns by leading commercial enterprises to em- 
 ploy recent college graduates trained in such subjects as chemistry, phys- 
 ics, electronics, mathematics, and biology, are having a definite effect 
 upon the decisions of young men and women to go or not to go into the 
 professional fields. 
 
 The inducements offered by both industry and government are a real 
 factor in the reduction of superior students who now apply for admission 
 to the medical schools of the country. The total number of applicants is 
 still sufficient to fill the classes of most medical schools that are not lim- 
 ited by geographical regulations, but there is a nation-wide need for a 
 greater number of better-qualified candidates. 
 
 If a sufficient number of competent physicians are to be educated to 
 meet the health needs of the future, it will be necessary to provide funds 
 from some or several sources to make it possible for well-qualified stu- 
 dents without financial resources to pursue a professional education and 
 career. It is difficult to imagine a more important area of our national life 
 to strengthen than assistance to deserving students who wish to devote 
 their lives to medical science and practice but who do not have the means 
 to pursue their calling. Efforts must be made by educational institutions 
 and others interested in this problem to recruit such men and women in 
 competition with other more immediately attractive and far less de- 
 manding opportunities. Such a plan of recruitment, however, would pay 
 a large return in future contributions to the welfare of the country. 
 
 The maintenance and improvement of the physical and mental health 
 of the population are among the primary responsibilities of any nation. 
 Health ranks in importance with other major features of the national 
 economy, such as food supply, housing, employment, education, indus- 
 trial and agricultural production, and social security. 
 
 The level of any health service depends upon the competence of those 
 who participate in and direct it. The future well-being of the people will 
 
88 New Challenges 
 
 depend in considerable measure upon the continuing supply of competent 
 physicians. The production of competent physicians by the teaching 
 institutions will depend upon adequate facilities, financial support, the 
 recruitment of a sufficient number of well-prepared students, and par- 
 ticularly the maintenance of a staff of qualified scientists and clinicians 
 dedicated to the education of physicians and other professional personnel. 
 
 Prepayment plans for hospital and medical services, which have 
 brought "the magic of averages to the rescue of millions," are having a 
 pronounced impact upon the financing of those services. The inflationary 
 spiral has also had a notable effect upon fees and hospital costs. The 
 growth of knowledge with consequent specialization within the profes- 
 sion has introduced many new problems, partly answered by the evolu- 
 tion of group practice, preventive medicine, and emphasis again upon the 
 individual and family as the units of medical care. These and other de- 
 velopments have produced considerable disruption in the older methods 
 and forms of practice. 
 
 Adaptations of medical and hospital services to the changing economic, 
 social, and professional conditions are to be expected. They have created 
 apprehension and fear on the part of those who are obliged to meet new 
 situations. These are evolutionary adjustments identified with progress, 
 although new methods, just because they are different, are not neces- 
 sarily better. 
 
 STAFFING PROBLEMS 
 
 In view of the heavy duties upon the staffs, particularly in the clinical 
 departments, many medical schools have put the appointments in those 
 departments on one or another type of full-time employment in order to 
 insure proper instruction of students, the conduct of research, and the 
 supervision of hospital services. These developments have increased the 
 effectiveness of instruction, the productivity in research, and the quality 
 of patient care in the university hospitals. 
 
 Some of these developments, however, have led to a new series of chal- 
 lenges, namely those from the profession itself. Its recent efforts, partly 
 through legislation, to regulate the methods of compensating teachers in 
 medical schools and university hospitals have created serious problems, 
 especially in institutions dependent upon tax sources of support. 
 
New Challenges 89 
 
 The teaching institutions which have the function of preparing the 
 future generations of physicians should be encouraged to employ full- 
 time teachers and investigators under any reasonable plan satisfactory to 
 the staff members and the school that will strengthen and improve the 
 quality of instruction. They should have the support of the profession 
 and hospital associations in their endeavors to maintain the quality of 
 teaching which, in turn, will insure a high level of health services for the 
 future of the country. They should be free from hampering regulations 
 of the medical profession or restrictive legislation which might interfere 
 with their essential functions in a modern society. 
 
 During 1955-56 the faculty, in cooperation with the Medical Board of 
 Presbyterian Hospital, made a study of the over-all staffing problems of 
 the Medical Center. The Joint Committee of the faculty and the Medical 
 Board of the hospital undertook to reaffirm the original objectives of the 
 Medical Center, with particular emphasis upon the tradition of educa- 
 tion and research that has been developed during the last twenty-eight 
 years. The second purpose was to evaluate the trends in current profes- 
 sional practice, community activities, and the national economy which 
 have had an impact on the functions originally outlined. 
 
 Special attention was given to the growth of scientific knowledge and 
 its application, the influence of the inflationary spiral, the high level of 
 prosperity in the country, the effects of changes in the age composition 
 of the population, and the growth of prepayment medical and hospital 
 insurance plans, as illustrations. 
 
 A number of these elements have contributed to the gradual shift in 
 the center of gravity toward private practice in the clinical departments 
 and toward the expansion of research activities conducted largely with 
 funds from outside sources. Those patients on the ward services who have 
 medical insurance in addition to the hospital coverage have presented a 
 series of new problems, particularly in relation to the payment for profes- 
 sional services rendered by residents and full-time members of the staff. 
 
 The growth of research and the demands for investigative work have 
 seriously overtaxed the laboratories of the Medical School but, because of 
 the outstanding eminence and abilities of many of the personnel, the de- 
 mand continues unabated for further expansion of these activities. 
 
 In making its study, the Joint Committee bore in mind the importance 
 
90 New Challenges 
 
 of keeping the entire program in reasonable balance. The conclusions 
 indicate that some reorganization is needed in certain instances in order 
 to relieve current pressures or to correct any unwarranted deviation from 
 the primary purposes of the institution. A summary was prepared of the 
 reviews conducted periodically during the last twenty-five years, to- 
 gether with an indication of the extent to which the recommendations 
 have been met. Studies were also made of the relationships of the resi- 
 dency programs at the Medical Center, including those at the New York 
 State Psychiatric Institute and the Francis Delafield Hospital. The con- 
 clusions reached were: 
 
 i. The present clinical staff, except in a few instances, is larger than 
 necessary for the educational and patient needs of the Medical Center. 
 
 2. There should be a gradual reduction in the over-all clinical staff 
 through 
 
 a. Closer scrutiny of the educational, research, and patient needs of 
 services when new appointees are proposed in order that over- 
 crowding gradually may be controlled at the source. 
 
 b. Limitation of private office accommodations to five years for at- 
 tendings upon retirement at the age of 65 years, on condition 
 that they share those facilities with some other member of the 
 staff. 
 
 c. Reduction of office and admitting privileges of those attendings 
 who diminish their teaching and hospital responsibilities; oppor- 
 tunities for private practice at the Medical Center may thereby 
 be opened to the younger members of the staff who carry teach- 
 ing and hospital responsibilities and who will be the staff of the 
 Medical Center in the future. 
 
 3. The director of each service should be required to review and to re- 
 port to the hospital and the University annually the teaching, hospital, 
 and private practice activities of each member of his staff. 
 
 4. An Advisory Committee on Private Practice should be created with 
 the duty of consulting with and advising the directors of services in re- 
 gard to space and time allocations in the private practice facilities any- 
 where in the Medical Center. 
 
 5. The residency program, which has expanded greatly, represents a 
 
New Challenges 91 
 
 form of group practice which overlaps some of the functions of the 
 younger attending staff. It should be reviewed annually, with the view, 
 among other things, of maintaining clinical responsibilities for beginners 
 in practice. 
 
 6. The teaching and research activities of the attending and residency 
 staffs of the Francis Delafield Hospital and the New York State Psychi- 
 atric Institute should be integrated as fully as possible with the staffs of 
 the other units of the Medical Center. 
 
 7. Modern offices should be provided to accommodate not more than 
 the number of physicians presently located on the main, first, and fourth 
 floors of the hospital and in the private offices in the Neurological Insti- 
 tute, plus facilities for some members of the Psychiatric Service. 
 
 FINANCIAL ASPECTS 
 
 The problems of financing the numerous activities of the Medical 
 School proper, along with those of facilities for expansion, continue ur- 
 gent. The generous aid from the Ford Foundation, the Commonwealth 
 Fund, the National Fund for Medical Education, the American Medical 
 Education Foundation, and the P&S Alumni Association has made it 
 possible to continue the essential elements of the program without cur- 
 tailment. This has been realized in large measure because of the dedica- 
 tion of the professional staff to the ideals of university medicine. The 
 salaries of that staff still lag behind those in many other educational insti- 
 tutions, hospitals, industry, and governmental agencies. 
 
 The nongovernment grants-in-aid of various types have increased from 
 about $200,000 in 1 934-1 935 to $1,900,000 per year at present. The gov- 
 ernment grants and contracts (federal, state, and municipal) have risen 
 in the same period from none to over $2,850,000 annually. The total ex- 
 penditures under the Faculty of Medicine represented by the Educa- 
 tional Schedule of the University budget have risen from less than 
 $1,500,000 in 1930 to over $8,700,000 at present, exclusive of mainte- 
 nance of buildings, library expenses, and Bard Hall. The charges against 
 the unrestricted general income of the University are now lower than 
 they were a decade ago. 
 
 The more than five hundred grants-in-aid and contracts have been the 
 
9 2 
 
 New Challenges 
 
 chief source of support for most of the research programs of the school. 
 The distribution of expenditures under the Faculty of Medicine is ap- 
 proximately as follows: 
 
 Medicine 
 Public Health 
 Dentistry 
 Nursing 
 
 Percent of 
 
 Percent of 
 
 Percent of 
 
 General 
 
 Income of 
 
 Grants, Contracts^ 
 
 University 
 
 Special 
 
 Hospital 
 
 Income 
 
 Endowments 
 
 Reimbursements 
 
 16 
 
 10 
 
 74 
 
 12 
 
 5 2 
 
 36 
 
 85 
 
 I 
 
 M 
 
 38 
 
 I 
 
 61 
 
 NEW AGREEMENTS AND APPOINTMENTS 
 
 The new agreement on nursing between the University and the Hos- 
 pital was made effective June 29, 1955,* which modified the earlier plan 
 of cooperation. Miss Eleanor Lee, director of the Nursing Service of 
 Presbyterian Hospital to which position she was appointed by the hos- 
 pital on June 15, 1955, was appointed executive officer of the department 
 and professor of nursing in the University, effective July 1, 1955. She 
 will become associate dean (Nursing) of the faculty on July 1, 1958. 
 
 Dr. John K. Lattimer was appointed professor of urology and execu- 
 tive officer of the department on July 1, 1955, to succeed Dr. George F. 
 Cahill who retired. Dr. Ray E. Trussell was appointed DeLamar Profes- 
 sor of Administrative Medicine, executive officer of the School of Public 
 Health and Administrative Medicine, and associate dean (Public Health), 
 on July 1, 1955, to succeed Dr. Harold W. Brown. Dr. David Rittenberg 
 was appointed professor of biochemistry and executive officer of the de- 
 partment on July 1, 1956 ,to succeed Dr. Hans T. Clarke, who retired. 
 Dr. Frank Stinchfield was appointed professor of orthopedic surgery 
 and executive officer of the department to succeed Dr. Alan DeForest 
 Smith. Dr. William B. Seaman was appointed professor of radiology and 
 executive officer of the department on September 16, 1956, to succeed 
 Dr. Harold Jacox, who had acted as executive officer following the retire- 
 ment of Dr. Ross Golden in September, 1954. Dr. Gilbert P. Smith was 
 appointed associate dean (Dental and Oral Surgery) and executive officer 
 
 *See Appendix J. 
 
New Challenges 93 
 
 of the department on November 1, 1956, to succeed Dr. Maurice J. 
 Hickey. 
 
 Late in 1956 the trustees of the Hospital proposed a new agreement f 
 covering that part of the activities of the Medical Center that relate to 
 the Presbyterian Hospital. The new agreement was adopted by the Uni- 
 versity and Presbyterian Hospital, effective January 1, 1957, to replace 
 that of 1 92 1 under which the Medical Center was built and operated. It 
 has administrative features reminiscent of the plan of organization in 
 effect previous to the opening of the Center and which had been aban- 
 doned in 1928. 
 
 The Institute of Nutrition Sciences was created in the School of Public 
 Health and Administrative Medicine. Dr. William H. Sebrell, Jr. was ap- 
 pointed professor of public health nutrition, director of the Institute and 
 chairman of the Coordinating Committee of the Institute, effective Oc- 
 tober 1, 1957. Dr. Richard J. Cross was appointed assistant dean in charge 
 of the postgraduate program on March 1, 1957. 
 
 The Institute for Research in Mental Retardation was established in 
 October, 1957. Dr. Lawrence C. Kolb will serve as director of the Insti- 
 tute and chairman of the Coordinating Committee for the Institute. It is 
 hoped that progress can be made in this whole field through the integra- 
 tion of the research activities of the various departments working on dif- 
 ferent phases of the complex problem of mental retardation. 
 
 f See Appendix K. 
 
The Report on the 
 Educational Future of the University 
 
 In the fall of 1957 the preliminary draft of the report, The Educational 
 Future of Columbia University, was released. It outlined a broad, imag- 
 inative program for the entire University. The Faculty of Medicine wel- 
 comed the discussions, criticisms, and recommendations pertaining to its 
 areas of interest and responsibility. Medical education is dependent upon 
 general education, from which it derives its broad base in the liberal arts, 
 our American culture, and the sciences basic to the medical disciplines. 
 Certain of the conclusions appeared to be incomplete or inaccurate, and 
 some of the recommendations, as they affected the Faculty of Medicine, 
 were regarded in the light of current practices as unwise. 
 
 The great progress in medical education and research in the United 
 States during the last forty years, which has placed this phase of American 
 medicine in the forefront of the world, has been due in large measure to 
 the stabilization of the educational administration of departments 
 through the long-term appointments of executive officers and senior staff 
 members, both in the basic sciences and in the clinical departments. This 
 crucial development laid the foundations for the whole system of univer- 
 sity full-time teaching and research in medical schools in this country. 
 
 In the clinical departments the responsibilities extend into the wards 
 and clinics of the teaching hospitals without which modern professional 
 education and research could not be continued. It was the stabilization of 
 the Faculty of Medicine of Columbia University which made it possible 
 for it to develop one of the great programs of the world through collabo- 
 ration with the state of New York, the city of New York, a number of 
 voluntary hospitals, the large educational foundations, philanthropists, 
 and in recent years the federal government. 
 
 Assurance of stable departmental organization is fundamental in any 
 faculty of medicine for the recruitment of new staff, for imaginative 
 leadership and forward financing of research grants, for development of 
 
Report on the University's Educational Future 95 
 
 fellowship programs and for other elements of a sound professional edu- 
 cation. Without such assurance there is serious doubt that this University 
 could attract or hold outstanding scholars and young, potential leaders in 
 the sciences or the various divisions of clinical medicine, especially in view 
 of the fact that the practically universal pattern of other medical schools 
 is that of long-term appointments. For the reasons enumerated above, it 
 would seem unwise for Columbia University to depart from its present 
 indeterminate appointments of executive officers in the departments of 
 the Medical School. 
 
 It is fully appreciated that the proposal of short-term, renewable ap- 
 pointments of executive officers might be satisfactory in a department on 
 a general university campus where there is a considerable number of full- 
 time senior members of the staff and where single courses need not be 
 correlated with other departments. This would not be true in most of the 
 divisions of the Medical Faculty since they have only a small nucleus of 
 such individuals and all instruction must be integrated with that of many 
 other departments and hospital services. Furthermore, the entire four- 
 year program of the Medical School is a unit because of the necessity of 
 integrating the educational, research, and hospital responsibilities of all 
 of the departments. Any scheme that provided for frequent changes in 
 the leadership of individual departments would obviously create con- 
 fusion and ineffectiveness. 
 
 If the purpose of the suggestion is to secure periodic review of the 
 effectiveness or competence of executive officers, there are existing pro- 
 visions under the University organization for meeting such situations 
 and, when necessary, to change executive officers. It would be short- 
 sighted to adopt a plan that would abandon fifty years of effort in a sound 
 direction in order to pick up a rare instance of inadequacy. 
 
 SEPARATION OF SCHOOLS 
 
 The second major proposal that needs comment was the recommenda- 
 tion which suggested the separation of the Schools of Medicine, Dental 
 and Oral Surgery, and Public Health and Administrative Medicine. The 
 faculties of Dentistry and Medicine, including Public Health and Post- 
 graduate Medicine, were separate at the time the Medical Center was 
 opened although, even at that early date, it was the philosophy of the 
 
g6 Report on the University s Educational Future 
 
 University that all of the undergraduate and graduate medicine and 
 dentistry, public health, nursing and the ancillary health professions had 
 their roots in the basic medical, biological, and chemical sciences and that 
 in many respects all were interdependent. That was the well-defined basis 
 for the evolution of a unified faculty. 
 
 It was the decision of the faculties involved and the Trustees to seek 
 integration at the active, working level of the faculty rather than through 
 a detached, purely administrative office which had been fully considered 
 several times in the past. The several professional schools were placed in 
 the Medical Center in 1928 as a first step in the integration of these 
 health service groups. Another indication of that policy occurred in 1934 
 when the deanship of the School of Dental and Oral Surgery was vacated. 
 The Trustees appointed the Dean of the Faculty of Medicine to that 
 post. The University statutes have provided since 194Q that the vice- 
 president in charge of medical affairs must be the dean of the unified 
 Faculty of Medicine. Columbia has been widely applauded in university 
 and professional educational circles for its leadership in developing this 
 comprehensive concept of the health professions and of an integrated 
 educational program for them. Rather than abandon the plan that after 
 thirty years of progress is on the whole working satisfactorily, it might 
 be far wiser to make some other administrative rearrangements than the 
 proposal of separating the several professional faculties whose scientific 
 foundations are identical. 
 
 New plans of organization are being promoted in some of the large uni- 
 versities of the country, intended in part to relieve the heavy responsi- 
 bilities on the presidents of the institutions. Some of those which have 
 several faculties or schools in the health services have created vice-presi- 
 dents in charge of medical affairs (or similar positions) to coordinate the 
 administration of the separate schools in contrast with the traditional 
 Columbia plan of integration at the educational level. In many instances 
 the individuals selected for the positions have no professional qualifica- 
 tions or identity. The officer often is merely an interpreter of faculty pro- 
 grams whose knowledge of the details of departmental operation, per- 
 sonnel, research, and teaching programs, direction of professional needs 
 and other essential features of the educational efforts may be secondhand 
 and detached. The over-all programs will be handicapped if that official 
 
Report on the University s Educational Future 97 
 
 does not have perspective and the necessary background on which to 
 formulate value judgments of the order of magnitude of various inde- 
 pendent proposals in the health fields aimed at meeting the community 
 and national needs. 
 
 A parallel trend toward consolidating the individual voluntary hos- 
 pitals has gone forward at the Medical Center since 1928 concomitantly 
 with the University's program of integration in its Faculty of Medicine. 
 It is finally effected by all of the voluntary hospitals at the Medical Cen- 
 ter in 1944. The combined Faculty of Medicine had a great influence in 
 this noteworthy development and served as a binding cement for the 
 same purpose with the hospitals and health activities of the state and 
 city at the Medical Center and with other affiliated hospitals in the com- 
 munity. The reasons for discontinuing the present integrated plan should 
 be more compelling than are now evident because the record does show 
 a large measure of important progress and recognition locally, nationally 
 and internationally. 
 
 It has been the firm opinion of the Trustees and of the faculty groups 
 at the Medical Center that the coordination of the scientific and clinical 
 instruction and research was more educational than administrative. It 
 was the conviction that such integration could be carried out most ef- 
 fectively through a single faculty channel rather than separate compet- 
 ing groups. The substitution of multiple channels of communication, 
 authority and responsibility for dealing with the hospitals, the com- 
 munity agencies, the state of New York, the city of New York and the 
 divisions of the federal government might cause confusion and ineffi- 
 ciency. 
 
 COOPERATION WITH PRESBYTERIAN HOSPITAL 
 
 Reference was made in the report to the Joint Administrative Board. 
 In passing it might be remarked that that board is concerned with only 
 a part of the University's responsibilities at the Medical Center. The 
 University must deal in many instances directly with state, city, federal, 
 and other outside agencies supporting activities at the Medical Center, 
 and with the practicing professions, public health, postgraduate medi- 
 cine, outside affiliated hospitals, and other community agencies. 
 
 A number of specific items in the report had been dealt with in the 
 
98 Report on the University's Educational Future 
 
 past by the Faculty of Medicine. All of the proposals in the report had 
 been considered at one time or another, and some repeatedly, by the 
 Faculty of Medicine. A number had been actually in operation for a long 
 time, or for good reasons, have never been recommended for adoption. 
 Some of the most important features of the University's program in re- 
 lation to the health professions were omitted in the report. It is the hope 
 that when the report is further digested the Faculty of Medicine may be 
 consulted for its opinions and comments. 
 
 There is daily exchange of information and consultation (financial, 
 personnel, policies, etc.) and the closest kind of cooperation between the 
 Medical School administration and the hospitals at the Medical Center, 
 including Presbyterian Hospital, which is the only other unit involved 
 in the Joint Administrative Board. 
 
 The present cooperation between the Faculty of Medicine and the 
 Medical Board and administration of Presbyterian Hospital can be il- 
 lustrated by the fact that the Dean, as executive officer of the faculty 
 and vice-president in charge of medical affairs, is a member of all of the 
 major professional committees of the consolidated Presbyterian Hospital: 
 
 Medical Board 
 
 Executive Committee of Medical Board 
 
 Doctors' Private Practice Offices Committee 
 
 Advisory Committee on Private Practice (chairman) 
 
 Joint Committee on the Facilities of the Medical Center (co-chair- 
 man) 
 
 Planning Committee 
 
 Staff Committee 
 
 Residency Program Committee 
 
 Joint Diagnostic Laboratory Committee 
 The Dean was also chairman of the Committee on the Staffing of the 
 Columbia-Presbyterian Medical Center and was chairman of the earlier 
 Committee on the Future of the Columbia-Presbyterian Medical Center. 
 One recommendation alluded to the problems of this and other uni- 
 versities in providing adequately for the financial support of the staff of 
 the medical school where high standards of excellence in teaching, re- 
 search and patient care are maintained. This topic is actively under dis- 
 cussion by the Joint Committees of the faculty and the Medical Board 
 
Report on the University s Educational Future 99 
 
 of Presbyterian Hospital and is a part of the complex of modern medical 
 economics. It represents a major phase of medicine that has a long his- 
 torical background. 
 
 Attention might be directed to the fact that the diversion of fees from 
 private patients to be utilized jointly by the hospital and the University 
 as suggested by the report leads into the whole controversial area of 
 salaried "group practice," the "corporate" and "proprietary" practice 
 of medicine, the farming out of University responsibility through "con- 
 cessions," the numerous problems relating to priorities in the admission 
 of patients, offices, operating rooms and laboratory assignments, admin- 
 istrative control of income or hours or space for private practice in lieu 
 of University salaries, the impact of prepayment hospital and medical in- 
 surance, the new problems relating to fringe benefits of labor unions, the 
 partial control of medical school plans by outside organizations, and 
 many other questions of University as well as hospital, legal, and profes- 
 sional policies. 
 
 At present there are about 1 14 members of the staff on "geographical 
 full-time." They receive no, or only nominal, compensation from the 
 University for their instructional and hospital services. Capturing their 
 established or potential earnings from private practice for the use of the 
 hospital and University would require a reorganization of the staff and a 
 departure from the long-established policies of the Presbyterian Hospital. 
 It would also require a different interpretation of what is regarded as 
 "full-time" for clinical appointments. Proposals of this kind have been 
 considered and, in a limited degree, tried in the past. At the present time 
 a variety of flexible methods of dealing with these essentially economic as- 
 pects of the University's medical school staff are in operation. Ninety 
 percent of the clinical staff is on a part-time basis. They do a large part 
 of the teaching. 
 
 The Advisory Committee on Private Practice mentioned earlier now 
 clears all recommendations for hospital appointments involving private 
 practice admitting privileges. This consideration is now an integral part 
 of the conditions of nomination by the University to the Hospital for ap- 
 pointments in that institution. They are all cleared through the Com- 
 mittee on Administration of the faculty acting on behalf of the Trustees 
 of the University under the terms of the agreement between the Univer- 
 
i oo Report on the University s Educational Future 
 
 sity and the Hospital. This is another effort on the part of the Hospital 
 and the University to offset the tendency for the center of gravity to 
 shift further than it does toward private practice. 
 
 OTHER PROPOSALS 
 
 In regard to the preceding discussion it may be noted that of the 1,262 
 University appointees in 1956-57 under the Faculty of Medicine on 
 Schedule A of the budget fewer than ten received a salary of $10,000 or 
 higher chargeable to the general income of the University. The salaries 
 of others in this range were charged to the income from endowments 
 given for the purpose or to temporary grants and gifts. 
 
 The recommendation in the preliminary report regarding preparation 
 of the budget has been discussed on frequent occasions over the past 
 twenty-five years. Each year it has been agreed that the current manner 
 of dealing with that procedure through the executive officer and the 
 dean who represents the University administration is satisfactory to all 
 departments. 
 
 Comments in regard to the duties of the Dean of the Faculty of Med- 
 icine, who is by statute the vice-president in charge of medical affairs, 
 were misleading because the administrative organization is a team effort. 
 Appropriate responsibilities are delegated to the associate deans, the ex- 
 ecutive officers, the Committee on Administration, the several Commit- 
 tees on Instruction in Medicine, Graduate Medicine, Dentistry, Public 
 Health and Nursing, the various class faculties, office assistants, and others 
 necessary to carry out the educational and administrative obligations of 
 the school. This has proved to be good practice and has relieved many 
 individuals and departments of certain details, thus freeing them as far as 
 possible for their more essential functions of teaching, research and hos- 
 pital services. 
 
 The plan of organization has facilitated communication through the 
 various department heads and their immediate staffs. It is upon these 
 devices and the individual departmental staff conferences and the close 
 working relationship with the various committees of the Medical Boards 
 of the hospitals, including Bellevue Hospital, the Francis Delafield Hos- 
 pital and other affiliated institutions, that the overall problems and 
 policies of the University are transmitted. The general plan of coopera- 
 
Report on the University s Educational Future 101 
 
 tive responsibility through the single channel of a unified Faculty of 
 Medicine is operating with a high degree of success. 
 
 COMMENTS ON TEACHING 
 
 In regard to some of the recommendations regarding student matters, 
 it should be remarked that the Medical School has long been recognized 
 everywhere in the country as an outstanding leader in helping to lib- 
 eralize so-called "premedical" education in the colleges and had made 
 noteworthy contributions to this basic philosophy of college preparation 
 for professional studies. 
 
 Another proposal was to discontinue the twelve-month schedule. It is 
 known that several members of the Medical Panel of the President's 
 Committee, for reasons identified with their own special situations, have 
 favored the discontinuance of the present around-the-calendar plan for 
 medical students. It happens that this plan has now been widely copied 
 in this country because of its soundness. It grew originally out of the de- 
 cision that every third-year student should have an intensive clerkship in 
 the Department of Medicine in Presbyterian Hospital. Because of the 
 limitation of this hospital service, it is possible to take care of only thirty 
 students at any one time. For many years an elective was created for 
 certain students to take this clerkship in the summer preceding the third 
 year. 
 
 Under the previous plans, and those in common use in other medical 
 schools that follow the academic schedule, students sought employment 
 opportunities during the vacation months in quasi-medical, hospital, and 
 laboratory work, often with little or no educational supervision or con- 
 tent. The majority of the students on their own initiative sought em- 
 ployment in positions related to medicine. It seemed wise to formalize 
 this trend by bringing the practice under educational guidance, which 
 we did. 
 
 One important result has been a highly desirable integration of our 
 teaching plans with the hospitals. The opportunities in them which exist 
 twelve months of the year and twenty-four hours a day are now fully 
 utilized in the improvement of the instructional program. 
 
 More recently there has been added the emphasis on the election of 
 research assignments by the students and the telescoping of the third and 
 
1 02 Report on the University s Educational Future 
 
 fourth years to make such opportunities more easily available. The sug- 
 gestion in the report about giving them opportunities for research is 
 better carried out under the twelve months schedule than by returning 
 to the regular academic year. These and other considerations have lead 
 the students almost unanimously to support the program. There are cer- 
 tain departments where there are difficulties because of the small staff 
 but they are not insurmountable. It is the general consensus that the 
 mature young men and women at the age at which they are in Medical 
 School are not in need of the long-term vacation usually provided in 
 secondary schools. We have been successful in finding scholarship aid 
 from alumni and other non-University sources for students in lieu of their 
 summer earnings. It might be pointed out that there is no additional 
 cost to the University involved. 
 
 Comments might be made about other items in the general statement 
 such as academic appointments for senior hospital residents. That has long 
 been in effect. Mention is made of each professional school having its 
 own doctorate degree. The Medical School has had the Doctor of Med- 
 ical Science degree since 1932. Students doing advanced work in the basic 
 medical sciences are usually registered under the Faculty of Pure Science. 
 Many of them are working for the Ph.D. degree under that faculty. The 
 comments about the curriculum are items that have been and continue 
 to be constantly under consideration by the Committee on Instruction 
 of the faculty which is studying a number of the problems mentioned 
 and many others of even more importance. 
 
 On the whole matter of screening the students to which reference is 
 made in the report, it is doubtful if any medical school in the country 
 or any faculty anywhere has closer evaluation and appraisal of students 
 than this school. They are under constant surveillance in the laboratories 
 and in the clinics and wards of the hospitals where in the latter instance 
 they are assigned in small sections dealing directly with patient care and 
 learning by doing under close supervision of the instructional staff. This 
 is an essential method of instruction if we are to prepare practitioners 
 who upon graduation may safely be called upon to deal with matters of 
 life or death. 
 
 The academic mortality in the school is negligible. It is our opinion 
 that the real place for the evaluation of students is at the time of selec- 
 
Report on the University's Educational Future 103 
 
 tion for admission. Furthermore, the occasional dismissal of students 
 should not be on the basis of the opinion of a single department or par- 
 ticularly that of an individual. Hence, the device has been worked out 
 of action by class faculties as a whole, not by departments, on all matters 
 of promotion and readmission. 
 
 The idea of faculty advisors for students is largely theoretical and per- 
 haps of limited value for the more mature students of medical school age. 
 It has been tried here as well as at other medical schools. Professional 
 students in the small sections naturally gravitate toward such advisors 
 and secure invaluable assistance from their instructors as they proceed in 
 the normal course of contacts with members of the staff. 
 
 The recommendations in regard to nursing are not realistic. The ques- 
 tions raised were known to the Faculty of Medicine when it created the 
 present program in 1938. There are considerable differences between 
 nursing education and nursing services, particularly in hospitals. The 
 present flexible plan at the Medical Center is outstanding, perhaps the 
 best of its kind anywhere. 
 
 The recommendation that each department "direct its own person- 
 nel" is in effect now within the framework of a united faculty. The plan 
 in operation does not interfere with the internal functioning of the de- 
 partment but adds greatly to its strength, intellectual support and con- 
 tributions to its and the school's program. Introduction of a super-officer 
 for "adjustments" would seem to be neither necessary nor desirable. 
 
The New Horizons 
 
 Since the dawn of history there has been a thread of continuous effort in 
 every society to cure the sick, treat the injured, advance knowledge of 
 health, and train practitioners of the healing arts. Medical care in one 
 form or another is today among the few universal, world-wide needs of 
 mankind. Its future can only be assured through a program which will 
 continue the production, education, and effective utilization of physi- 
 cians and other professional health workers associated with them. Today 
 such an objective is one of the primary responsibilities of any nation and 
 must be closely related to other major activities of a modern society. The 
 provision of adequate health services is one of America's most essential 
 industries. It is one of the largest. It obviously requires a wide range of 
 trained personnel, technical knowledge and skills, facilities, adequate 
 financing, proper organization, good public relations, and all the other 
 elements of a comprehensive community service. 
 
 Many of the problems which American medicine and medical educa- 
 tion face must be considered in the broad context and perspective of cur- 
 rent social, economic, political, and educational changes. Change and 
 evolution are inevitable. Individuals, organizations, and educational pro- 
 grams must learn to adapt themselves to new and different conditions 
 without, however, surrendering certain fundamental principles and ob- 
 ligations. In spite of all of the ferment and the impact of many features 
 beyond the control of the medical schools, the elements of sound health 
 services and the preparation and dedication of the profession to its public 
 responsibilities must be retained. 
 
 The total outlay for health services, both governmental and private, 
 is about seventeen billions, per annum, including all forms of professional 
 fees, hospital charges, nursing, drugs, appliances, and other related items, 
 of which the private expenditures were between eleven and twelve billion 
 dollars. 
 
 The total expenditures are a small fraction of the national income and 
 insignificant when compared with the total values which the services aim 
 
New Horizons 105 
 
 to protect. It is worthy of note that the amount spent on medical educa- 
 tion itself, the most essential aspect of this whole program, is less than 
 one percent of the total of the private expenditures alone. 
 
 Among features of our complex society which have an impact on the 
 problems of medicine and medical education may be mentioned the in- 
 dustrialization of the country; the high rate of urbanization ; the migra- 
 tion of the population (during the last twelve months thirty-three mil- 
 lion people moved to new locations, the largest shift in history, mostly 
 through the development of suburbs of the metropolitan areas and loss 
 from the farm to the industrial states); the changing character of the 
 family itself as a social agency; new methods of communication and trans- 
 portation; the aging of the population, which is accompanied by an in- 
 crease in chronic diseases; the ever increasing complexity of scientific 
 knowledge with necessary specialization; the rising costs of health care; 
 the growth of prepayment insurance; the conduct of government largely 
 by pressure groups; the increasing voice the government has in all of our 
 daily activities; the emphasis on preventive medicine, mental disorders, 
 chronic illness, rehabilitation; and the extension of mass education. Yet 
 the needs of the patient and his family in matters of health, sickness, and 
 disability are still personal and individual. 
 
 These and other socioeconomic aspects of medicine and of medical edu- 
 cation have been recognized by the profession for some time: 
 
 A competent and effective plan of medical care for the nation is dependent 
 upon a body of trained personnel who are abreast of current knowledge and 
 skillful in its application. Any plan of organization, whether developed from 
 within the profession or imposed upon it from without, which lessens the re- 
 sponsibility of the trained physician or denies him the rewards of superior 
 ability and character will, in the long run, be detrimental to the public welfare. 
 No scheme of organization or group responsibility can substitute for the price- 
 less, discriminating, and sympathetic judgment of the competent and consci- 
 entious physician. 
 
 Inasmuch as the objectives of medical care can be attained only by trained 
 personnel, the educational features become paramount, not only in the recruit- 
 ment and training of students for the professional groups but also in the con- 
 tinuation education which will keep the members of these groups abreast of 
 new knowledge and methods. 
 
 The preparation of students for the newer obligations and opportunities of 
 the profession requires a sound training in the principles of the basic sciences, 
 
io6 New Horizons 
 
 which are likely to remain the foundation of medical practice, research, pre- 
 ventive medicine, and public health work. The training should emphasize, 
 however, that the forms and methods by which these principles are to be ap- 
 plied in meeting the needs of individuals and the community are likely to be 
 modified in the future. * 
 
 Medical education includes not only premedical preparation but also 
 the subsequent continuance of the educational process throughout the 
 internship, hospital residency, specialty training, and the continuation 
 education of physicians in practice. All features of the entire program 
 must contribute also to the obligation of physicians to participate in the 
 preparation, supervision, and guidance of the army of nursing, dental, 
 public health, and technical workers and lay employees of health institu- 
 tions and organizations as well as in the education of the public in health 
 matters. The medical schools occupy the central position in the guidance 
 and development of adequate health services of every kind and descrip- 
 tion for the entire population. 
 
 The medical school is always greater than the total of its parts. Its 
 existence is justified to the extent that it maintains excellence in per- 
 formance — education, research, hospital responsibilities, and public serv- 
 ice. The primary function is to create an environment in which well- 
 qualified students may acquire the knowledge, habits of study, basic skills, 
 sound attitudes, sense of personal responsibility for patients, and an un- 
 derstanding of the professional, community, and the ethical principles 
 that motivate the true physician. 
 
 CHANGES IN MEDICAL EDUCATION 
 
 The rapidly moving developments are reflected in a changing philos- 
 ophy of medical education. The new attitude is to regard it as a graduate 
 discipline requiring integration of the entire learning process. The whole 
 undergraduate course must be looked upon as a unit, not as a series of 
 independent and more or less watertight compartments. This is a charac- 
 teristic that distinguishes medical instruction from most other divisions 
 of the university. The objective is to produce upon graduation neither a 
 specialist nor a physician who can render every type of professional care 
 but rather one who, after an internship, is prepared to begin practice as a 
 
 *From the Final Report of the Commission on Medical Education (1932). 
 
New Horizons 107 
 
 well-rounded, competent, safe, and conscientious family physician or to 
 go forward into advanced work in a limited field. 
 
 Another feature of our present-day educational plan is to select self- 
 starting, self-directing, and self-propelling students who have a broad 
 cultural background rather than a concentration in the sciences and 
 who, under the guidance and supervision of skilled teachers, may secure 
 the elements of a real education which, at the professional level, must 
 always be largely self-education. In the instruction itself the emphasis is 
 placed increasingly on the longitudinal nature of disease and the changes 
 that occur in the individual throughout his entire life span rather than 
 on the occasional acute illness or episode of disability. 
 
 NEW PLANS AND METHODS 
 
 Importance is increasingly being placed in the evaluation of the student 
 upon his ability to think for himself; to demonstrate initiative, imagina- 
 tion, intellectual curiosity, scientific critique, and resourcefulness; to face 
 alternatives and to make decisions; and to develop understanding of 
 diseases and of people rather than knowledge of them alone. The reliance 
 is being placed upon performance, judgment, discrimination, and in- 
 tellectual self-reliance which reveal the intangibles and imponderables 
 that mark the true physician. 
 
 While it is highly important that the purely intellectual talents of the 
 student should be developed to the fullest, it is also vital that the qualities 
 of temperament, human sympathy, and insight which are required for 
 dealing with the manifold human problems of medical care should be 
 emphasized. The physician needs an understanding of, and must be able 
 to treat, the man as well as the disease. 
 
 In view of the broadening concepts of professional education, new 
 methods and plans of instruction have been introduced here and in other 
 progressive schools. Many of them are really only modifications of old 
 and tried methods, sometimes adopted on the assumption that if pre- 
 sented as being different, they may be better. Without doubt the merit 
 and acclaim attached to most of the "new" plans and developments, are 
 attributable in large measure to the lively enthusiasm of the staff and a 
 fresh concentration on teaching. The staff are stimulated, organized, and 
 sometimes financed sufficiently to insure success of the program. 
 
108 New Horizons 
 
 The Columbia Faculty of Medicine has introduced and for years has 
 been using some of the sounder ideas that others are now promoting. It 
 maintains its long-established practice of continuous appraisal of the in- 
 structional program through its Committee on Instruction, the Com- 
 mittee on Administration, and the Faculty itself. The problem is not so 
 much of tinkering with the curriculum — an activity that has little or 
 nothing to do with real education — but rather with the dynamics of 
 learning and the intimate daily association of students with interested, 
 devoted, and inspiring teachers. 
 
 Among the devices that may be mentioned and which are utilized in 
 our teaching program are the group clinic; various forms of family 
 medical care plans with which our students are made acquainted; direct 
 supervision of students who are in the process of learning by doing under 
 supervision; integration of the instruction of several different depart- 
 ments through interdepartmental committees and its periodic review by 
 the respective class faculties; erasure of many of the traditional lines be- 
 tween disciplines, which leads to a far more closely integrated program 
 than in the past; shifting of the focus of instruction from expounding by 
 the teacher to learning by the student; emphasis on developing the stu- 
 dent's powers of observation and critical faculties rather than merely 
 training his memory; the growing attention to the problems of aging, 
 chronic diseases, rehabilitation, mental disorders, and prevention; presen- 
 tation of more comprehensive and fewer lectures; review of the basic 
 sciences in the clinical years and, conversely, early introduction of the 
 clinical concepts into the basic sciences; dependence upon individual 
 supervision of students in ward and clinic teaching; correlation clinics 
 throughout the medical course; demonstration and interpretation 
 through the patient's medical history of the social and economic aspects 
 of his daily life (these factors contribute to the diagnosis, treatment, and 
 follow-up of his illness) and particularly how he reacts and adapts himself 
 to them; the effective supplementary teaching in affiliated community 
 hospitals, municipal as well as voluntary; elective periods of research in 
 which increasing numbers of students are participating; and careful 
 scheduling, for greater effectiveness, of the time and efforts of students 
 and faculty. 
 
 The widespread adoption of the clerkship plan of teaching in the 
 
New Horizons 1 09 
 
 clinical years well illustrates the effort to place the student in a position 
 not so much to memorize and learn facts but quickly and confidently to 
 mobilize the knowledge which he has accumulated. He is called upon to 
 select, examine, and judge pertinent data of the patient's history, family 
 environment, laboratory findings, and other features that contribute to 
 the problem on hand in order that he may formulate a reasonable ap- 
 praisal of the existing condition. Since no two patients are identical, it 
 seems only reasonable to assume that the manner in which such a student 
 conducts himself, the judgment that he shows, the resourcefulness and 
 ingenuity which he may display in arriving at sound conclusions are pro- 
 cedures which can only be judged over a long period of observation and 
 supervision. The evaluation is a constant process. 
 
 The results of some of the progressive planning of the medical course 
 may be illustrated by a few comments. The schedule in the clinical part 
 of the course is on a twelve-month basis instead of an academic year. One 
 twelfth of the students are on vacation each month. This makes it possible 
 to integrate the teaching schedules with the actual operation of the hos- 
 pitals and clinics at the Medical Center and in affiliated institutions. 
 
 Under the arrangement, the third-year students register immediately 
 upon completion of their second year. In effect, the student remains in 
 constant session from the beginning of his second year until graduation, 
 except for a one-month vacation each year. The total effect of this length- 
 ening of instruction has been to provide about five academic in four 
 calendar years. It has permitted the more leisurely study of many prob- 
 lems of medicine and longer student contacts with patients and their 
 problems in the various clinics and clerkships. It has also given the student 
 a real sense of responsibility very like that which he will later assume 
 when he goes into hospital training or medical practice. It also has al- 
 lowed him, under the system of electives, to set aside long periods for re- 
 search and investigation which are recognized as highly important tools 
 of real education. 
 
 The further development of correlation clinics in the first year has been 
 gratifying. Members of the basic science faculty and the clinical depart- 
 ments collaborate in presentation of the relations of these basic sciences 
 and the medical problems which the student is likely to see later in indi- 
 vidual patients. The social, environmental, occupational, and other 
 
i io New Horizons 
 
 phases of patient care are presented by members of the different staff 
 groups dealing with those problems. Similarly, the members of the medi- 
 cal sciences participate in the fourth-year combined clinics. 
 
 The integration of psychiatry into the four years of instruction has 
 been highly promising. This has been brought about by the close co- 
 operation of all of the clinical disciplines. The whole person and his mani- 
 fold problems are considered, not just his specific medical or surgical 
 needs at the time. 
 
 The plan has also been carried into the residency system of the Medical 
 Center under which the residents in the New York State Psychiatric 
 Institute are appointed initially in Presbyterian Hospital, where they 
 work on the wards of general medicine, surgery, obstetrics, and pediatrics. 
 
 Special seminars and organized presentations on cancer, cardiovascular 
 disorders, and other major phases of medicine and on the social and eco- 
 nomic problems of patient care give the students a real understanding of 
 comprehensive medicine. The emphasis again is on putting before the 
 students the broad concepts of their responsibilities as physicians, not 
 alone for the professional care of the sick but as community leaders and 
 citizens. 
 
 The Group Clinic initiated years ago but still actively in use as a device 
 for instruction and organization of the outpatient services is one of the 
 most important innovations in this school and is a program which is being 
 copied elsewhere. Between fifteen and twenty students are on service at 
 any one time throughout the calendar year. The plan gives the student 
 experience in his senior year in the operation of group practice of the 
 highest order with special emphasis upon the key position of the internist 
 or "family physician" in the scheme of medical practice and service. 
 
 PREPROFESSIONAL EDUCATION 
 
 The very nature and breadth of community and public as well as profes- 
 sional responsibilities which devolve upon the physician requires sound, 
 thorough and comprehensive preparation for the study of medicine. A 
 true liberal education is an essential requirement for the physician of the 
 future. 
 
 As stated in 1932, "the tendency of medical schools and regulatory 
 bodies to define the range and character of premedical preparation is 
 
New Horizons 1 1 1 
 
 contrary to the spirit of real education, which should be general and not 
 preprofessional in purpose. A sound general education is of more value 
 to students of medicine than a narrow technical training in the premedi- 
 cal sciences."* It must stimulate an intellectual and spiritual life as a part 
 of the permanent equipment of the individual, with a spirit and eager- 
 ness for learning. 
 
 The essential requirement is to help each student find himself as an 
 individual and to provide the opportunities and stimulus for him to de- 
 velop his own interests and ideas that will be enduring. What medicine 
 and the community need are physicians who are broadly educated men 
 and women rather than narrowly trained technicians and craftsmen. The 
 preprofessional preparation should provide the student with an appreci- 
 ation of his own as well as other cultures, and the historical record of 
 man's achievements — social, intellectual and artistic— as well as an under- 
 standing of the physical and biological world. The most important ob- 
 jective may be knowledge of himself, his gifts, limitations, motivations 
 and aspirations. 
 
 THE LENGTH OF PROFESSIONAL TRAINING 
 
 The question of adequate preparation in liberal education for the needs 
 of medical education introduces the complex problem of the length of 
 time required to produce a physician. Telescoping the professional and 
 the undergraduate college courses was a common practice for years and 
 is now being revived. The introduction of the longer hospital period of 
 training plus the requirements of military service after graduation have 
 intensified the challenge to reduce the long span of professional educa- 
 tion. In the long run the most satisfactory solution may be not to inter- 
 fere with the medical course per se, which is currently undergoing in- 
 tensive revisions and improvements, but to strengthen and vitalize the 
 period of secondary and college education. 
 
 The preparation for admission to professional studies is an essential 
 part of medical education broadly conceived. It is gratifying to know that 
 the efforts to strengthen the academic programs in the undergraduate 
 colleges currently are producing results, although everyone is aware of 
 the overwhelming prospects of excess student enrollments in the next 
 
 *From the Final Report of the Commission on Medical Education (1932). 
 
ii2 New Horizons 
 
 decade. The emphasis is being placed upon deepening the intellectual ex- 
 periences for upper classmen through honors programs, utilization of long 
 vacations, various types of advanced placement programs, and intensive 
 instruction through new techniques and other devices. In its finest form 
 the preprofessional liberal arts period, which in the colleges that provide 
 the highest quality of instruction reaches its culmination in the last year, 
 should give the student an opportunity to understand, appreciate, and 
 share the cultural heritage of our civilization. To curtail that oppor- 
 tunity, which comes only once in a lifetime, and limit the college seg- 
 ment for physicians largely to an abbreviated contact with a true liberal 
 arts preparation and a condensed curriculum in the basic sciences, sup- 
 plemented by superficial acquaintance with a few social problems, may 
 not serve the best purposes of the profession and, in the long run, of the 
 nation. 
 
 Since most medical schools will probably continue to select the best 
 qualified, most broadly educated, and mature students who apply to 
 them for admission, any shortening of the time needed to produce a 
 competent physician will of necessity be dependent in part on how the 
 whole structure of secondary and college education is now being modified. 
 It is the common experience that the superior students who would best 
 be able to complete a shortened course are more likely to spend extra 
 time during their professional course, and often are encouraged to do so. 
 
 COMMUNITY ASPECTS 
 
 Medicine has accepted, or had thrust upon it, community responsibilities 
 of the broadest character. Medical instruction today recognizes and is 
 attempting to deal with the social, economic, emotional, and environ- 
 mental elements of illness and incapacity in individuals. These considera- 
 tions need not and cannot substitute for a thorough grounding in the 
 basic scientific disciplines, but they should supplement and vitalize that 
 education because the future of medical practice, medical care, and pub- 
 lic health is dependent in the long run upon progress and research in the 
 basic sciences. 
 
 The pressure of economics, inflation, expanding hospital responsibili- 
 ties, and other featurss, over which the medical schools and the parent 
 universities have little control or the necessary resources to direct, are 
 
New Horizons 1 1 3 
 
 modifying the earlier concept of the strictly university medical school. 
 The ability of hospitals, because of their flexible and more readily avail- 
 able sources of income, to meet the changing economic conditions and 
 their responsibilities for the intern and residency training explain in part 
 their increasing role in medical education and research. 
 
 HOSPITAL RELATIONSHIPS 
 
 The medical school, because it is the direct link between the teaching 
 hospital and the community, must be much more than a training device 
 for physicians. The functions include the mobilization of the support of 
 the resources of the university and of the modern hospital as they con- 
 tribute in different ways to the diagnosis and treatment of disease, the 
 prevention of illness and disability, the advancement of knowledge of the 
 basic and clinical sciences, and the guidance of individuals and the com- 
 munity in health matters. 
 
 RESEARCH 
 
 Research is an indispensable ingredient of dynamic medical education. 
 Efforts artificially to separate them or to divide the simultaneous re- 
 sponsibility of faculty members for both are unrealistic and illogical. 
 Separation is possible in noneducational governmental agencies, isolated 
 research institutes, and industrial organizations but would interfere with 
 the proper functions of a university school of medicine. 
 
 It is the responsibility of medical faculties to apply as fully and 
 promptly as possible the potentials of the underlying biological and phy- 
 sical sciences and to convert such knowledge to its application to health 
 problems. That this has been widely recognized by the public is evi- 
 denced by the many local and national voluntary agencies which through 
 publicity and fund-raising efforts have built up support particularly for 
 individual diseases and for specific projects. 
 
 In recognition of the vital role of research in the efforts of the faculty 
 and the urgent need of facilities in which to carry forward its dynamic 
 programs, plans have been drawn for the new library and research labo- 
 ratories at the corner of 168th Street and Fort Washington Avenue. 
 These new units, when completed, will almost double the facilities of the 
 Medical School in the various basic science and clinical departments and 
 
ii4 New Horizons 
 
 provide modern and badly needed library accommodations. Plans also 
 include the erection of an auditorium with approximately 750 seats to 
 meet the needs of instruction of students, practicing physicians, public 
 meetings, and alumni activities. 
 
 THE MEDICAL CENTER IDEA 
 
 The universities and the medical profession are the trustees of the 
 essential knowledge which will contribute substantially to the solution 
 of the problems of individual and national well-being, happiness and 
 vigor. Possessing that knowledge, they are in a position to make, and are 
 challenged by the responsibility of making, a vital contribution to the 
 public welfare. Medicine and the universities must be willing to supply 
 leadership and a proper perspective regarding the essential contributions 
 of the allied professions in meeting the present-day health needs of com- 
 munities and the nation. In fact, they are doing so in many areas, not the 
 least of which is the creation of the team concept of the medical center. 
 The role of the medical center is in direct response to the obligations of 
 medicine and hospitals to meet conditions in this changing world. The 
 center represents the mobilization of professional talents, research, and 
 education in a combined assault on the health problems through provid- 
 ing the highest quality of diagnosis, treatment, and prevention of diseases 
 and disability. It reaches its fullest measure of usefulness when adequately 
 supported by the medical and allied professions, the community it serves, 
 state and private financial resources for training, research and patient 
 care and, above all, by the continued educational leadership of the uni- 
 versity. 
 
 These broad considerations of the direction of development and chal- 
 lenge of medical education in the changing world have had a great deal 
 of attention from the faculty. Every effort is being made to implement 
 and apply the latest concepts of medical responsibility. This grows out 
 of the recognition that the crucial element is the individual student, upon 
 whose character, attitude, preparation, ability, and industry so largely 
 depend the results of professional education. 
 
 The second essential ingredient in a truly successful program is a staff 
 of dedicated, interested, enthusiastic and competent individuals in all 
 divisions. It is the general concensus that in the clinical departments the 
 
New Horizons 115 
 
 staff organization should comprise a flexible combination of strictly full- 
 time, geographical full-time, part-time, and residency appointees, and 
 that efforts be made to increase the number of positions on a strictly 
 full-time basis in departments which now have them and to extend the 
 plan to other divisions of the faculty. There is agreement that all ap- 
 pointments on a geographical full-time basis be made only in relation to 
 the primary purposes of the Medical Center which are education, re- 
 search and hospital service. In order to meet the responsibilities ahead it 
 will be necessary to plan for modern offices and ancillary facilities for a 
 properly balanced staff made up in the clinical divisions of strictly full- 
 time, geographical full-time, and part-time appointees. 
 
 The programs of the Faculty of Medicine and of the outstanding insti- 
 tutions with which it is affiliated have deep and solid foundations, upon 
 which even greater structures of education, research and public service 
 can be built. What has gone before is but a prologue to the accomplish- 
 ments that lie ahead. Based on the vision of its founders, the dedication 
 of its staff and students to the highest ideals of medical science and prac- 
 tice as related to the needs of our American society and of the world to- 
 day, the Faculty of Medicine looks forward with confidence to its ability 
 to continue in the future its contributions in medical education, research 
 and the health and welfare of the country. 
 
 Professor H. Houston Merritt was appointed Acting Dean and Acting 
 Vice-President in Charge of Medical Affairs to succeed Dr. Rappleye, 
 effective July 1, 1958. 
 
Appendices 
 
Appendix A 
 
 Letter from Mr. Edward S. Hardness to Mr. Robert W. de Forest, Chairman 
 of the Building Committee of the Presbyterian Hospital, dated December 
 19, 1910. 
 
 Dear Sir: 
 
 It has recently come to my attention that a basis of alliance has been sug- 
 gested between The Presbyterian Hospital and the College of Physicians and 
 Surgeons, the medical school of Columbia University, by prominent members 
 of both institutions, subject to the settlement of details and to the approval of 
 governing boards of these institutions. This alliance is singularly in line with 
 my own conception of the proper relations between hospital and medical school, 
 and I should be glad to further it. 
 
 I have long been interested in that form of charity which has to do with the 
 treatment of human ills, and latterly have become more and more impressed 
 with the extent of the work that a hospital must do on the broadest scientific 
 and practical lines if it at all adequately uses its resources. 
 
 The scientific development of medicine has especially interested me recently, 
 and I have become convinced that its real underlying province and mission to 
 humanity lies more particularly in preventing disease than in merely curing it. 
 All this has increased a growing desire I have had to contribute something 
 which will materially increase the usefulness of a great hospital. 
 
 I am convinced that this scientific development can best be accomplished in 
 the hospital and the medical school, and that the two are interdependent, the 
 one on the other. The medical school constantly supplies the physicians and 
 surgeons of the future who in their early training must have every facility for 
 practical experience and application, which they can only obtain at a hospital 
 where they are taught by the practicing physicians and scientific men. The 
 hospital supplies a vast amount of material for study and research, and should 
 realize that besides caring for the sick, it has a great obligation towards human- 
 ity to use this material both in the training of the younger men and in further- 
 ing discoveries in preventive medicine. 
 
 I believe that the visiting staff of a hospital does better work for its patients, 
 and that its members are kept more up to date, if they include teaching in 
 conjunction with their duties than otherwise; that the hospital and patients 
 directly benefit thereby, the former through attracting a better class of internes 
 
1 20 Appendices 
 
 and attendings because of the teaching facilities, the latter through receiving 
 more careful attention and the latest methods of treatment. 
 
 I realize that one of the Presbyterian Hospital's greatest needs in its new 
 hospital plant is a surgical pavilion supplying ample bed facilities and embody- 
 ing modern appliances. 
 
 With these needs in mind, I shall be glad to provide the cost of the erection 
 upon a site belonging to the Hospital, of a surgical pavilion containing one 
 hundred and fifty beds and equipped with modern appliances and, conven- 
 iently accessible to this pavilion, a complete laboratory for advanced research 
 work. 
 
 It also gives me pleasure to offer to the Hospital, on behalf of a donor whose 
 name I am not now at liberty to mention, money and securities which I esti- 
 mate to be of the value of $1,300,000, in trust for endowment, the principal to 
 be kept separate from other funds and the income to be used exclusively 
 towards the support of the scientific and educational work connected with the 
 Hospital and referred to in this letter. As I withhold the name of the donor, I 
 guarantee the payment or transfer of this endowment fund to the Hospital. 
 
 This donor and I would like the privilege of placing appropriate tablets in 
 the new pavilion stating in whose memory the building is erected and the work 
 endowed, and I should wish the privilege of approving any building plans that 
 may be determined upon and to have a voice in the selection of an architect, 
 although I do not urge this last point. 
 
 Both of the offers above contained are made on the following understanding 
 and conditions: 
 
 1. That the Hospital shall admit to the wards students of the medical school 
 to the extent and in the manner permitted by the most approved practice. 
 
 2. That the educational institution concerned may make nominations to all 
 positions on the Hospital staff, medical, surgical and special. 
 
 3. That the persons occupying for the time being the ranking or foremost 
 professorships in medicine and surgery in the educational institution concerned 
 shall always be nominated to appropriate positions on the staff of the Hospital 
 and that so long as they hold such offices in the Hospital they shall have no 
 official connection with any other hospital, to the intent that under this agree- 
 ment the Hospital will secure in the treatment of its patients the greatest de- 
 gree of medical and surgical skill which can be furnished by the school. 
 
 4. That the physicians and surgeons of various ranks and their assistants shall 
 have as full privileges as reasonably possible, consistent always with the welfare 
 of patients, of instructing their students in the public wards and the various 
 laboratories of the Hospital. 
 
Appendices 1 2 1 
 
 5. That the departments of pathology and bacteriology may give teaching 
 to students in the Hospital. 
 
 6. That there shall be a Director of the surgical research laboratory who 
 shall teach in the Hospital and who shall always be on the active teaching staff 
 of the school. 
 
 7. That the surgical department at the Hospital shall publish an annual re- 
 port of the scientific and clinical work of the year. 
 
 8. That the College of Physicians and Surgeons, the medical department of 
 Columbia University, be the medical school with which the Hospital makes 
 this arrangement, so long as it is in a position to carry out its share of these 
 conditions and complies therewith. Should it not be in such a position, or fail 
 to comply therewith, another medical school of the first rank may be selected 
 by the Hospital. 
 
 9. That if the Hospital shall not comply with the conditions named in this 
 letter, and should such noncompliance continue after notice and reasonable op- 
 portunity to fulfill the same, the Hospital shall forthwith pay and transfer to 
 me or the donor whom I represent, as I may request, the whole of the endow- 
 ment fund herein referred to. If this non-compliance should occur after my 
 death the repayment shall be made to any person or institution designated for 
 that purpose in my will. After such default and until such payment, the endow- 
 ment fund shall be held by the Hospital in trust solely to make such payment. 
 
 The conditions imposed by this letter may from time to time be changed by 
 mutual agreement. My own consent, if living, and that of the Hospital shall be 
 necessary to such change; after my death the person or corporation thereto 
 authorized by my will may consent in my place. 
 
 While the medical school will benefit from the gifts herein made, and this is 
 expected and desired, its only right to such benefit must come through agree- 
 ment with the Hospital, the school itself having no right hereunder. 
 
 Should any of the details of this offer be inconsistent with the necessary basis 
 of the management of the Hospital, or should there be other details which in 
 your opinion should be considered by me, I shall be glad to confer with you 
 with respect thereto. 
 
Appendix B 
 
 Agreement between Presbyterian Hospital and Trustees of Columbia College 
 April 25, 191 1. 
 
 AGREEMENT made this 25th day of April, 191 1, between the Presby- 
 terian hospital in the city of new york (a corporation organized under the 
 laws of the State of New York hereinafter called the Hospital), party of the 
 first part, and the trustees of Columbia college in the city of new york 
 (a corporation organized under the laws of the State of New York hereinafter 
 called the University), party of the second part. 
 
 The Hospital maintains and has for many years maintained a General Hos- 
 pital in the Borough of Manhattan, City of New York. 
 
 The University maintains and has for many years maintained in the same 
 Borough a Medical School (known as the College of Physicians and Surgeons) 
 in which instruction is given to students in the theory and practice of medicine, 
 and scientific research is carried on. 
 
 The parties to this agreement are united in the belief that a permanent al- 
 liance between the Hospital and the University will render the Hospital more 
 useful; will enable it to serve the needs of both patients and the community 
 more efficiently; will secure the best professional service for the Hospital; and 
 will make the Hospital a centre of larger influence, by promoting education, by 
 advancing knowledge, and by exemplifying the best in practice; and also that 
 such an alliance will benefit the University by enabling it to give the best 
 clinical instruction to its students and afford improved opportunities for ad- 
 vanced study. 
 
 The Hospital has heretofore purchased certain land lying between Sixty-sixth 
 and Sixty-seventh Streets, Avenue A, and the East River, in the Borough of 
 Manhattan, as well as other adjacent land, and purposes to erect thereon hos- 
 pital buildings; and the Hospital and University are both desirous that the 
 buildings so to be erected shall be used as fully as practicable, consistently with 
 their hospital use, for scientific and educational purposes. 
 
 In order to assist the Hospital in constructing such buildings; and in order to 
 enable it to carry on its work upon the broadest scientific and practical lines, to 
 promote the training of physicians and surgeons by affording the students facil- 
 ities for practical experience and application which they can only obtain in a 
 well-equipped hospital, and to promote the scientific development of medicine 
 
Appendices 123 
 
 in the prevention as well as the cure of disease, Mr. Edward S. Harkness has 
 offered to provide the cost of the erection upon the said lands belonging to the 
 Hospital of a surgical pavilion containing one hundred and fifty beds and 
 equipped with modern appliances, and a complete laboratory for advanced re- 
 search work conveniently accessible to the said pavilion. Mr. Harkness has 
 further offered to the Hospital (on behalf of a donor whose name he does not 
 now desire to mention) money and securities which he estimates to be of the 
 value of $1,300,000 in trust for endowment, the said sum to be invested and 
 the income thereof used exclusively toward the support of the scientific and 
 educational work connected with the Hospital, all upon the terms and condi- 
 tions set forth in his letter of December 19, 19 10, a copy of which is appended 
 to this agreement as Schedule D. This fund is hereinafter called the Harkness 
 Fund. 
 
 The Hospital has accepted the gift of Mr.^Harkness under the terms of his 
 letter. 
 
 In order to comply with the conditions of the said offer by Mr. Harkness 
 and in consideration thereof and in order to accomplish the above purposes 
 the Hospital and the University have agreed with each other to establish a 
 permanent alliance and have entered into this agreement upon the following 
 terms: 
 
 First. The Hospital and the University shall each continue its independent 
 corporate existence and control. 
 
 Second. Unless some other arrangement shall be made from time to time be- 
 tween the parties, the income of the Harkness Fund as received shall be paid 
 over monthly to the University to be applied by it exclusively to carrying on 
 the scientific and educational work connected with the Hospital as hereinafter 
 provided. The University shall pay to the Hospital monthly the proportion of 
 charges due by it for operation, maintenance and interest under the Ninth 
 article of this agreement. The University shall annually furnish to the Hospital 
 an account made up to the end of its academic year, to wit, the thirtieth of June 
 in each year, showing its receipts from the said fund and the disbursements made 
 therefrom ; and shall at the same time pay back to the Hospital such surplus (if 
 any) as there may be of receipts above expenditures. Any such surplus received 
 by the Hospital shall, as may be agreed upon, either be added to the principal 
 of the Harkness Fund and invested and kept invested with the original prin- 
 cipal, or shall be used exclusively toward the support of the scientific and edu- 
 cational work as provided in this agreement. 
 
 Third. The Hospital shall erect upon the lands above mentioned a general 
 hospital, including the surgical pavilion above mentioned, having a total ca- 
 pacity of not less than three hundred beds and having all the usual accessories 
 of a well-equipped general hospital, including a suitable out-patient depart- 
 
124 Appendices 
 
 ment; and shall equip and maintain the same and continue to carry on the work 
 of a general hospital. 
 
 Fourth. The Hospital shall admit to its wards students of the said College of 
 Physicians and Surgeons to the extent and in the manner permitted by the 
 most approved practice. 
 
 Fifth. The University shall make nominations to all positions on the Hospital 
 staff, medical, surgical and special, including under this description all positions 
 now classed in the report of the Hospital for the year ending September 30, 
 19 10, under the titles House Staff, Dispensary Staff, Pathological and X-Ray 
 Departments, and all other positions of a similar character that may hereafter 
 be created, including the Director of the Surgical Research Laboratory men- 
 tioned in Clause Seventh of this agreement. To make this privilege effective 
 the Hospital will make its appointments to such positions from persons nomi- 
 nated to it by the University. Should any such nomination be unsatisfactory 
 to the Hospital it shall be withdrawn and another nomination promptly sub- 
 stituted until a nomination satisfactory to the Hospital shall be made. In case 
 of failure to secure a nomination satisfactory to the Hospital after twelve 
 months from the time when the vacancy shall occur and after not less than 
 three nominations for such vacancy shall have been made by the University, 
 the names of all such nominees, together with the names of any other nominees 
 which the Hospital may propose, not exceeding three in number, shall be sub- 
 mitted to the Board of Arbitration mentioned in Clause Seventeenth of this 
 agreement, who shall report upon the relative fitness or unfitness of such 
 nominees and their relative standing and merits. Thereafter such vacancy shall 
 be filled by the Hospital from the nominations submitted to the Board of 
 Arbitration. It is agreed that the persons occupying for the time being the 
 ranking or foremost professorships in medicine and surgery in the College of 
 Physicians and Surgeons shall always be nominated to appropriate positions 
 on the staff of the Hospital, and that so long as they hold such offices in the 
 Hospital they shall have no official connection with any other hospital; it being 
 the intent of this agreement that the Hospital shall secure for the treatment of 
 its patients the greatest degree of medical and surgical skill that can be furnished 
 by the College of Physicians and Surgeons. 
 
 Sixth. The physicians and surgeons of various ranks and their assistants shall 
 have as full privileges as reasonably possible, consistent always with the welfare 
 of patients, of instructing their students in the public wards and the various 
 laboratories of the Hospital. The Departments of Pathology, Bacteriology, 
 Biological Chemistry and such other educational and scientific departments as 
 may be hereafter created by mutual agreement shall also have the like privilege 
 of teaching students in the Hospital. 
 
 Seventh. There shall be a Director of the surgical research laboratory above 
 
Appendices 1 25 
 
 mentioned who shall teach in the Hospital and who shall always be on the 
 active teaching staff of the College of Physicians and Surgeons. 
 
 Eighth. The medical and surgical departments at the Hospital shall prepare 
 an annual report of the scientific and clinical work of each year, which shall be 
 published by the Hospital. 
 
 Ninth. The University agrees to meet all the cost of carrying on the scientific 
 and educational work of the Hospital, provided that the income of the special 
 fund given to the Hospital by or through Edward S. Harkness, which amounts 
 to $1,300,000, shall be applied, as received, to whatever extent may be neces- 
 sary to pay this cost. The said cost of carrying on the scientific and educational 
 work shall include the entire expense (including salaries) of clinical instruction 
 in the Hospital and of conducting the departments of Pathology, Bacteriology, 
 Radiography, Biological Chemistry and such other educational and scientific 
 departments as may be hereafter created by mutual agreement; and also the 
 salaries and supplies required for all laboratories connected therewith, including 
 the laboratory for advanced research work mentioned in Mr. Harkness' letter. 
 It shall also include the cost of all equipment, apparatus and instruments used 
 in such departments or laboratories, and the service rendered by such depart- 
 ments and laboratories to the other work of the Hospital. It shall also include 
 the cost of operating and maintaining those parts of the Hospital plant which 
 are to be used for carrying on scientific and educational work, and interest upon 
 the cost of the said parts of the Hospital plant. The charges last mentioned are 
 to be ascertained and computed in the manner provided in clauses Tenth and 
 Eleventh of this agreement. Such charges shall not in any year exceed the 
 amount of income received from the Harkness Fund, unless the University so 
 agrees. 
 
 Tenth. The share of the cost of operation and maintenance of the Hospital 
 buildings which is to be paid by the University, shall be such proportion of the 
 cost of operation and maintenance of the entire Hospital plant, as the cubic 
 space occupied for scientific and educational work shall bear to the cubic space 
 occupied for all the work of the Hospital. This proportion shall be ascertained 
 as soon as the plans for the complete group of buildings comprising the Hospital 
 plant are finally agreed on; and it shall be stated in the form of a percentage, in 
 a supplementary agreement between the Hospital and the University. In case 
 of additions to the Hospital buildings thereafter, the percentage shall be re- 
 computed and stated in a further supplementary agreement. Those parts of the 
 Hospital plant of which the University is to pay the cost of operation and 
 maintenance, are set forth in Schedule A, hereto annexed. The items of Hos- 
 pital accounts which enter into the cost of operation and maintenance within 
 the meaning of this agreement, are set forth in Schedule B, hereto annexed. In 
 computing the cubic space occupied for scientific and educational work and the 
 
126 Appendices 
 
 cubic space occupied for the other work of the Hospital respectively, those 
 parts of the Hospital buildings which have a common use shall be excluded from 
 the computation, a list of such parts of the Hospital buildings being contained 
 in Schedule C, appended hereto. This division of the cost of operation and 
 maintenance may be changed at any time by mutual agreement in writing if 
 it fails to conform to the general principle of this alliance. 
 
 Eleventh. In order to compute the amount of interest charges to be paid by 
 the University as above provided, the entire cost of the whole group of Hospital 
 buildings, including the cost of the land, shall first be ascertained; provided, 
 however, that the cost of lands owned by the Hospital but not used for Hos- 
 pital purposes shall not be included until so used. The same percentage that is 
 to be used to acertain the University's share of the cost of operation and main- 
 tenance of buildings, shall then be applied to determine the sum upon which 
 the University shall pay interest. And the rate of interest to be paid by the 
 University upon the sum so determined shall be the annual average rate of the 
 income earned by the investments of the Harkness Fund for the previous fiscal 
 year ending September 30th. The Hospital, under its system of accounting, 
 now charges off each year for depreciation one and one-half per cent, on the 
 cost of its buildings with their equipment. The accounts on which this per- 
 centage is charged are designated "Buildings Account" and "Machinery and 
 Tools Account." The object of this has been to keep book values near to actual 
 values. The University's proportion of this allowance, not exceeding this ratio, 
 unless some other rate be mutually agreed upon, shall be reserved from the in- 
 come of the Harkness Fund and be applied to reconstruction or replacement 
 whenever necessary. This will lessen accordingly the book values of the Hospital 
 plant on which the interest charges above referred to will be figured. 
 
 Twelfth. Plans of the new Hospital plant shall be made in conference with 
 the University and, as respects those parts intended for scientific and educa- 
 tional work, subject to its approval, so that accommodation for educational and 
 scientific work may meet its requirements; but the Hospital shall not be under 
 obligation to expend more than $200,000 upon those parts of its plant intended 
 for scientific and educational work, unless a larger expenditure be mutually 
 agreed upon. 
 
 Thirteenth. The work done by the School of Nursing shall not be deemed 
 educational or scientific work within the intent of this agreement. 
 
 Fourteenth. The Hospital shall meet the entire cost of all apparatus and in- 
 struments intended for the diagnosis or treatment of patients and used in de- 
 partments of the Hospital other than the scientific and educational departments 
 above mentioned. 
 
 Fifteenth. All accounts of either Hospital or University relating to matters 
 
Appendices 127 
 
 which may arise under the terms of this agreement, shall be open to proper 
 examination and verification by the parties hereto. 
 
 Sixteenth. Neither the University nor the Hospital shall be under any im- 
 plied obligation, responsibility or liability of any kind whatsoever, except as 
 provided in this agreement, and all and every such obligation or liability shall 
 be limited to the duties and obligations expressly and in terms assumed and 
 agreed to by each party. 
 
 Seventeenth. It being realized that no precise estimate can now be made of 
 the contributions by the University to the cost of maintenance and operation 
 or of the payments by the University by the way of interest, and that many 
 questions may arise incident to carrying out this agreement and the general 
 principles upon which it is based, it is hereby agreed that all matters arising at 
 any time hereafter under this agreement, as to which the parties shall not agree, 
 shall be submitted to a Board of Arbitration, to be appointed as follows: 
 
 The said Board shall consist of the President of the Presbyterian Hospital, 
 or some person appointed by him; the President of Columbia College in the 
 City of New York, or some person appointed by him; and the President of 
 Johns Hopkins University, or some person appointed by him. In case the Presi- 
 dent of Johns Hopkins University shall decline to act upon the said Board of 
 Arbitration, or to appoint some person to represent him, then the third mem- 
 ber of said Board shall be the President of The Rockefeller Institute, or some 
 person appointed by him. All appointments of persons to represent the said 
 Presidents may be either for a definite period, or at the pleasure of the Presi- 
 dent making such appointment, or for the decision of some particular question. 
 The decision of the said Board of Arbitration shall in all cases be final and con- 
 clusive upon the parties hereto. Its report on the fitness or unfitness of nominees 
 under Article Fifth shall be deemed an advisory report and not a decision 
 binding on the Hospital. 
 
 Eighteenth. Should either party fail to comply with a decision of the said 
 Board of Arbitration or refuse or neglect to enter into such arbitration, and 
 such refusal or failure continue after notice and reasonable opportunity to 
 comply therewith, the other party may at its option terminate this agreement 
 by written notice to that effect. Such termination shall not affect any obligation 
 existing at or before the time of the termination. 
 
 Nineteenth. The conditions of this agreement may from time to time be 
 changed by mutual consent. 
 
 In Witness Whereof the parties to this agreement have caused the same 
 to be duly executed the day and year first above written. 
 
Appendix C 
 
 Excerpts from "Memorandum on the Ideal Development of Hospital and 
 Medical School" by Dr. Samuel W. La?nbert, March, 1912. 
 
 Completed Institution of the Alliance. — The conditions presented here 
 for a final solution of this problem are probably not complete, but it is hoped 
 they will serve as a beginning and will excite further discussion of the many 
 points at issue. The final end to be secured, if possible, is to develop a com- 
 bined hospital, educational and scientific medical centre in which all the special- 
 ties of medical practice shall have opportunity and room in which to develop. 
 The Presbyterian Hospital has at present and probably would have expected 
 to duplicate in its new buildings in case no alliance with Columbia University 
 had been perfected, the following departments: 
 
 1. A general medical service. 
 
 2. A general surgical service. 
 
 3. A children's service, which is mostly for children over two years of age. 
 
 4. A dispensary service for outpatients, which includes a partial list of the 
 specialties of medicine, at present there are classes in children, in nervous 
 diseases, in eye, in throat, in skin, in genitourinary diseases and in gynaecology. 
 
 5. A pathological department, including bacteriology and chemistry. 
 
 6. A Roentgen ray department. 
 
 The Columbia University in addition to its other school facilities now sup- 
 ports the following departments and foundations, which are more or less fully 
 devoted to clinical purposes: 
 
 1. Complete laboratory plants for pathology, clinical pathology, bacteri- 
 ology, biological chemistry and pharmacology. 
 
 2. The Sloane Hospital for Women. 
 
 3. The Vanderbilt Clinic, which is an outpatient service containing classes 
 in all the specialties of medicine. It has extensive laboratories for diagnosis and 
 special therapeutic plants for mechanotherapy and hydrotherapy. 
 
 The terms of the alliance between the two institutions provide that the 
 Presbyterian Hospital Trustees maintain a hospital and the Columbia Trustees 
 maintain a medical school and support the educational and scientific work of 
 
Appendices 119 
 
 the hospital. On this basis of mutual support the hospital will give up its 
 pathological and its X-ray departments and delegate this work to the Univer- 
 sity. In order that this combination of interests may be properly carried on, 
 the two institutions must build new plants in close physical contact and on 
 the best lines and plans which the conditions and general contour of New York 
 will permit. Columbia should rebuild the Sloane Hospital as a part of the gen- 
 eral plant and also a new Vanderbilt Clinic in close relation both to the new 
 Sloane and to the new general hospital of the Presbyterian Hospital corpora- 
 tion, and also to any other new hospitals or services for medical specialties which 
 may be secured. The Presbyterian Hospital should not develop a new out- 
 patient service, but should ally itself to the new Vanderbilt Clinic, which 
 should thus become the dispensary of the hospital. 
 
 The new feature of the combination of hospital and school, which is sug- 
 gested above, is the development of ward services for all the specialties repre- 
 sented in the Vanderbilt Clinic, which would automatically become the out- 
 patient services of those ward services. The addition of such ward services for 
 medical specialties to a general hospital is a further development of the present 
 practice of many such hospitals. Certain general hospitals have special wards 
 for gynaecology, for orthopedic surgery or for eye diseases. Many such hospi- 
 tals, of which -group the Presbyterian Hospital is one, have a special ward 
 service for children. From the point of view of the school and of medical edu- 
 cation every specialty should have its ward service and its dispensary service. 
 If any of the existing hospitals in New York devoted to special work could be 
 persuaded to form an alliance with the University similar to the fundamental 
 one between the Presbyterian Hospital and Columbia a great step in advance 
 would have been taken. Every inducement should be extended to such hos- 
 pitals, especially to those which have antiquated plants, to consider the ad- 
 vantages to themselves of such an alliance. The needs of the various specialties 
 are perhaps too great to be included in a general hospital, and it may be neces- 
 sary to include special plants for all of them. In any case the securing of sufficient 
 land to meet the possible demands in this direction will do much to bring about 
 the desired end. 
 
 In conclusion, this fact must be insisted upon, that to the future belongs 
 only the application of the general principles involved for the first and greatest 
 and most difficult step has been taken and the alliance between the Presby- 
 terian Hospital and Columbia marks the beginning of the first real medical 
 center in New York. 
 
Appendix D 
 
 Memorandum on the School of Medicine by Dr. William Darrach, Decem- 
 ber 13, 1919. 
 
 I. The Objects of the School of Medicine of Columbia University shall be: 
 
 (a) to train men and women to be physicians of the highest type and to de- 
 velop leaders of medical thought; 
 
 (b) to test and increase our knowledge of the art and science of medicine and 
 to foster research; 
 
 (c) to apply that knowledge to the prevention, cure or alleviation of human 
 ills. 
 
 II. In planning for such a school we must differentiate between that portion 
 of the entire scheme which is essential for the development of a medical school, 
 designed to accommodate a definite number of students for the degree of M.D., 
 and other portions not essential to this primary purpose but necessary to com- 
 plete the organization in its fullest possibilities. 
 
 Such subdivision can be illustrated by two concentric circles. In the smaller 
 circle would be included, besides the school and laboratories, a general hospital 
 and dispensary of sufficient size to supply the clinical material necessary for 
 research and the undergraduate teaching. 
 
 In the larger circle would be included special hospitals or institutes for the 
 better development of the special branches. 
 
 For the present we shall deal only with the smaller circle, leaving the out- 
 lying portion for further consideration. 
 
 III. To institute and carry on such a school of medicine it is necessary to 
 obtain: 
 
 Land sufficient in amount to accommodate the various buildings required at 
 present and to allow for future development. The site should be convenient to 
 clinical material and to the various methods of transportation of the city. 
 
 Buildings to accommodate the various departments of the school, the labora- 
 tories, hospital, dispensary and dormitories for the students. These units must 
 be so arranged as to allow the intimate correlation and coordination of teach- 
 
Appendices 1 3 1 
 
 ing, research, and care of the sick so necessary for the full development of each. 
 The school, hospital, dispensary, and laboratories are so inderdependent that 
 their unity must be realized geographically as well as functionally. 
 
 Endowment sufficient to make it possible for the University to carry the 
 greatly increased medical school budget involved in the proposed plan of or- 
 ganization. 
 
 IV. The Medical School 
 
 1 . The Student Body. Numbers 
 
 The natural desire on the part of a university is to accommodate as many 
 properly qualified students as apply to the institution. But in the teaching of 
 medicine it must be accepted that there is a definite limit beyond which a single 
 unit cannot expand without lowering the quality of the instruction given. 
 When the demand sufficiently exceeds this limit it should be met by duplicat- 
 ing the unit, rather than by crowding the facilities. It is believed that today 
 such a limit is reached when a single class reaches 100. 
 
 It is more difficult to expand in the later clinical years, when facilities depend 
 on hospital bed capacity, than it is in many of the laboratory courses in the 
 first two years. For this reason the number admitted to the first two years 
 should not exceed the accommodations of the later years. It should not be taken 
 for granted that a certain percentage of those entering will fail to qualify for 
 advancement, but it should be possible always to carry through to graduation 
 all who are allowed to enter if their work is satisfactory. Vacancies will always 
 probably occur and these can be well filled by admitting to advanced standing, 
 students from other schools who may prove their fitness by proper tests. 
 
 Quality 
 
 The quality of the applicants for admission will naturally improve with the 
 quality of the teaching and the general reputation of the school. And it should 
 be possible, with a limitation of numbers, to select those who are best qualified 
 for the work. Such a selection must be made with great care. It may soon be 
 necessary to require three instead of the present two years of academic work, 
 which must include a sufficient amount of physics, chemistry, biology, French 
 or German, and English. But other methods must also be devised for the de- 
 termination of a candidate's fitness for the study of medicine. His mental and 
 personal qualification may be tested by a psychological examination and his 
 record in his premedical work should be taken into account. 
 
 2. Officers of Instruction. 
 
 The success of such an institution will depend more on the character of the 
 teaching body than upon any other one factor. 
 
132 Appendices 
 
 The selection and further development, not only of the heads of the depart- 
 ments but also of their associates and assistants, must be matters for the exer- 
 cise of the greatest care and wisdom. 
 
 In their selection, the three-fold purpose of the institution — teaching, research, 
 and the application of knowledge — must be borne in mind. In making appoint- 
 ments, irrespective of the grade, every attempt should be made to find and ob- 
 tain the best available man for the position, wherever he may be. After care- 
 fully canvassing all possibilities, expert advice should be sought from outside 
 the institution before the decision is made. 
 
 The character of the teaching personnel will depend also on the opportunities 
 offered them. This includes both a proper salary and facilities for work. The 
 former should be adjusted to the needs of the individual. For the full-time 
 worker, whether he be in a laboratory or a clinical department, the salary 
 should be sufficient to free him from the necessity for outside employment. For 
 the part-time worker whose main income is derived from other sources, the 
 salary need be much less. But all men who are actually engaged in teaching 
 should, if possible, have some financial reward in addition to the honor and re- 
 spect the position brings. 
 
 Of more importance than salary for either type of man is the proper arrange- 
 ment of his work, so that he shall be freed from unessential details and useless 
 waste of time. In the end the opportunity to carry on teaching and research 
 under wholesome conditions is the most effective force for bringing into the 
 medical school men of ability and ideals. 
 
 3. Organization. 
 
 The school and hospital should be organized and administered so as to include 
 men who are qualified in all three branches — teaching, research and the applica- 
 tion of knowledge to the care of the sick. Each individual need not possess all 
 three qualifications, but all must be represented and balanced throughout the 
 school. 
 
 There should also be such cooperation and coordination not only within each 
 department but between the different departments as will weld them all to- 
 gether into a single well-balanced unit. 
 
 (a) Laboratory Department. 
 
 The heads of many of these departments have long been on the full-time 
 basis, and with no legislation they have voluntarily refrained from any outside 
 employment. The results in the advancement of knowledge have proved the 
 value of such an arrangement. 
 
 There must be no curtailment of the fields of investigation in these depart- 
 ments. They must be free to study and develop any part of their particular 
 science. At the same time they should consider their problems from the stand- 
 point of medicine as a whole. They must remember that they are primarily 
 
Appendices 133 
 
 parts of a medical school and a hospital for the sick, lest their teaching lose that 
 vital contact with medicine which is so essential to the best development of its 
 art and science. 
 
 This better cooperation will be greatly aided by the geographical union of 
 the laboratories and the hospital and therefore with the clinical departments. It 
 can also be helped by including among the lower grades of their personnel, men 
 who are being trained for the clinical departments. By serving a limited time 
 in several of the laboratory branches, the younger men will gain a wider and 
 firmer foundation for their clinical work. This arrangement has long existed in 
 the Anatomical Department and a large percentage of the surgical personnel 
 are serving, or have served, as demonstrators of anatomy for two to ten years. 
 
 (b) Clinical Department. 
 
 The main clinical departments shall be reorganized on the full-time basis — 
 Medicine and Surgery immediately, and Pediatrics as soon as financial and 
 clinical facilities permit. It is hoped that other departments may later be 
 similarly arranged. 
 
 At the head of each shall be placed a man of such training, ability, and char- 
 acter that he may assume full responsibility for and the direction of the general 
 policies of the department, the character of the teaching, the hospital service, 
 and the nomination of his associates. It shall be his duty to develop a modern 
 clinic of the best type. 
 
 Before considering further the organization of these departments, the follow- 
 ing discussion of the "full-time" plan seems warranted by the existing am- 
 biguity of the term, as evidenced by the widely divergent plans of organization 
 now in force or planned throughout the country. 
 
 In the earlier days of medical education, practitioners gave a portion of their 
 time to teaching. At first a student became associated with a practising physi- 
 cian who gradually taught him in all branches of the art. 
 
 Later schools were formed where physicians concentrated their efforts on one 
 branch of the subject. 
 
 At another period it was realized that if teachers were to keep abreast of the 
 knowledge of the day and to make any independent advances, it was necessary 
 for them to devote most of their time to investigation and teaching in their 
 own particular branch. This plan of concentrated effort was first adopted in the 
 laboratory branches and for a number of years, the leaders, and most of their 
 assistants, in the departments of Anatomy, Chemistry, Physiology, Pathology, 
 and Bacteriology, have been men who have completely given up or have never 
 entered the practice of medicine. The results in the betterment of teaching and 
 in the advancement of knowledge have well proved the wisdom and necessity 
 of such an arrangement. 
 
 Lately a similar development has been taking place in the clinical depart- 
 ments. In several medical schools the departments of Medicine, Surgery and 
 
1 34 Appendices 
 
 Pediatrics are being reorganized on what is spoken of as the "full-time" or 
 "university" basis. It is being widely accepted that such an arrangement is 
 necessary for the best type of teaching, for the most successful clinical investi- 
 gation and for the most skillful care of the sick. 
 
 The essential principle of this arrangement is that the dominating group of 
 men in the main clinical departments must be free to concentrate their energies 
 on their university and hospital work. There are two main factors which tend 
 to interfere with this freedom, no matter how sincere the intentions of the men 
 may be. These factors are insufficient assistance and the distractions of private 
 practice. By providing the full-time men with sufficient assistance, professional, 
 clerical, technical and menial, he may relieve himself of such unnecessary de- 
 tails as he desires. He must also be protected from the demands of private prac- 
 tice. The main purpose is to obtain a more truly university type of clinical 
 teacher. The full-time plan is a means to this end — a method by which it may 
 be obtained. Neither the time element nor the question of fees is, in itself, the 
 essential point, and these must not be confounded with the primary object. 
 
 There is apparently but little question in the minds of medical educators as 
 to the wisdom and necessity of this main principle. There is, however, some 
 doubt and much discussion concerning the details of organization. This is 
 evidenced by the wide variation among the plans now in force and among 
 others suggested. The main difficulty lies in the question of private practice. 
 As a man's value as a clinician increases, the demands made for his services by 
 the public naturally increase. If this increasing demand is satisfied he will have 
 less and less time for his university duties. It therefore becomes necessary for 
 these men to control the amount of private practice they shall do and the 
 conditions under which it is done. 
 
 The various so-called full-time plans may be summarized as follows: 
 
 Plan i . No private practice and no outside employment. 
 
 Plan 2. Private practice at the discretion of the clinician but no fee is paid for 
 
 such service. 
 Plan 3. As in Plan 2 except that the fee is paid to the University. 
 Plan 4. Private practice for fees allowed in such limited amounts that it does 
 
 not interfere with the thorough, efficient and sincere fulfillment of his 
 
 academic duties. 
 Plan 5. Unlimited private practice within the hospital. 
 
 Plan 1 has not been tried. Plan 2 is in effect at the Rockefeller Hospital and 
 is the plan that will be recommended in this memorandum. Plan 3 is applied 
 at Johns Hopkins. Plan 4 is in effect in several schools. Plan 5 was suggested in 
 191 1, but it is not in effect. 
 
 From an administrative standpoint Plan 1 would be the simplest method. 
 The full-time men would limit their clinical experience to the wards of the hos- 
 
Appendices 135 
 
 pital and the dispensary. It seems unwise to deprive the public of these men's 
 services, for patients who are not eligible for the charity wards are at times of 
 great scientific, educational, or humanitarian interest. 
 
 Plans 2 and 3, where practice is restricted by removing the financial induce- 
 ment, remove the above objection. The payment of the fee to the University, 
 however, is strongly criticised by many men and is not entirely satisfactory to 
 some of the men who have been working under that arrangement. Of the two, 
 therefore, Plan 2 seems to be the preferable one. 
 
 If Plan 4 were used the hospital would place a limited number of private 
 rooms with office facilities at the disposal of men working on this basis. These 
 men could then spend a large part of if not all of their time in the school and 
 hospital. This plan, however, cannot be combined with Plan 2 without intro- 
 ducing a discordant element into the situation. The specific plan to be proposed 
 for adoption therefore discards men on the Plan 4 basis. 
 
 Plan 5 is the one suggested by the Faculty of the College of Physicians and 
 Surgeons in 191 1 but does not meet the requirements of today, as with un- 
 limited facilities within the hospital such private practice might well claim the 
 major portion of a man's attention. 
 
 These five variations have all been spoken of as "Full-time" plans. Plans 1, 
 2, and 4 are consistent with the present statutes of Columbia University as to 
 full-time service. 
 
 The success of any plan will depend on the character of the man in question 
 and the spirit of the school. Any form of legislation will be unavailing if the 
 wrong men are appointed to these positions. There are many forms of distrac- 
 tion besides private practice, especially in New York City, which might lure a 
 man from proper fulfillment of his academic duties. Some definite conception, 
 however, is necessary in formulating any such reorganization. 
 
 Specific Plan Proposed. 
 
 The fundamental principle upon which these departments shall be reorgan- 
 ized is that the control of each main clinical department shall be vested in a 
 director associated with a differentiated group of men who are devoting all 
 their time to the school and hospital, that they may build up and maintain a 
 department where the best intensive clinical investigation and scientific re- 
 search may be carried on with the teaching of students and the care of the sick. 
 
 In order to achieve this end it is believed to be wisest so to organize these 
 departments that the director with all of his associates (those in charge of por- 
 tions of the hospital service) and as many of his other assistants as he desires 
 and can afford, shall be on the basis of Plan 2. They would see private patients 
 at their discretion for scientific, educational, humanitarian, or personal reasons, 
 and when they do, no fee would be paid for such service. The head of the de- 
 partment shall not only be responsible for the general policies of the whole de- 
 partment, for the character of the teaching and for the nomination of his associ- 
 
136 Appendices 
 
 ates, but he shall be given every facility to develop a well-rounded, modern 
 clinic, with sufficient clinical material in both wards and dispensary, with the 
 specialized assistants, professional, clerical, and menial he requires, and the 
 necessary laboratories. 
 
 To carry on efficiently the teaching of two classes of 1 00 men each in a clinical 
 department, it is necessary to have a large corps of assistants. Especially is this 
 true as the older lecture method is more and more replaced by recitations, con- 
 ferences, and practical work at the bedside, in the laboratories, and dispensary. 
 Even if it were advisable to have the entire department on a full-time basis, 
 the expense in certain departments would be enormous and the plan therefore 
 impractical. In addition to the group characterized above as under Plan 2, the 
 conduct of hospital, dispensary, and school requires additional assistance from 
 men giving only part of their time to hospital, dispensary and school. The ex- 
 tent to which they are used should vary with the ideas and plans of the respec- 
 tive directors, provided they are not made an essential part of the hospital or- 
 ganization. 
 
 The salary of the men on the Plan 2 basis should be sufficient to make them 
 independent of any private work and that of the director should be enough to 
 allow him to assume the position in the world that he deserves. The men on a 
 part-time basis will require a much smaller salary than that of the full-time men. 
 
 The head of the department with these associates should form an adminis- 
 trative board, which could relieve him of as much of the administrative details 
 of the hospital and of the teaching as he chose. Unless he is so relieved and pro- 
 tected from the innumerable distractions of departmental matters he will prove 
 sterile as a producer and will soon cease to be the inspiring and stimulating 
 leader so necessary in a department of this kind. These men should have as 
 much time for constructive thought and productive leisure as the head of a 
 large industrial concern. By such a combination and coordination the depart- 
 ment would become a well-rounded unit, which should result in great progress 
 along all three lines — research, teaching, and care of the sick. 
 
 V. Administration. 
 
 There should be a large deliberative body to include all teachers who are in 
 charge of courses. 
 
 There should be a separate legislative body made up of the heads of the De- 
 partments of Anatomy, Bacteriology, Biological Chemistry, Neurology, Ob- 
 stetrics and Gynecology, Pathology, Pharmacology, Physiology, Practice of 
 Medicine, Pediatrics, and Surgery. 
 
 There should be a small administrative body with whom the Dean could advise 
 as often as was necessary. 
 
 VI. Hospital and Dispensary. 
 
 The University Hospital must be in close geographical and functional rela- 
 tion to the medical school. 
 
Appendices 137 
 
 It must be planned to contain sufficient beds to supply the clinical material 
 necessary for classes of 100 students. The school should then limit its under- 
 graduate teaching to the University Hospital, except where the clinical ma- 
 terial proved insufficient, as for instance at the present time in psychiatry, 
 tuberculosis, and infectious diseases. 
 
 If the student is to have a complete picture of a disease, and of more im- 
 portance, if the patient is to be properly cared for, a longer stay in the hospital 
 should be planned than is now the custom in most of the New York hospitals. 
 The demand for beds is so great that patients are often discharged as soon as 
 they are able to stand the trip home and before they are really able to resume 
 their home duties. This should be arranged for by providing good convalescent 
 facilities, a good "follow-up system" and by a more generous supply of beds. To 
 satisfy these conditions there should be 200 beds for Medicine, 200 for Surgery, 
 and 250 for the other specialties. The number of beds in a general University 
 Hospital which shall be assigned to each of the specialties should be small, as it 
 should aim to satisfy only the demands for undergraduate teaching. 
 
 It is hoped that later on special hospitals such as the Sloane Hospital for 
 Women may be obtained adjacent to the University Hospital for each of the 
 specialties. As these become available, the beds in the general hospital assigned 
 to that specialty will be released and would be ready to satisfy new demands as 
 they arise. In this way the normal increase will be accommodated for some 
 years to come. 
 
 It is hoped that the Vanderbilt Clinic will be moved with the school and 
 built on such a scale as to include the outpatient function of that hospital. 
 
 VII. Summary. 
 
 The three-fold purposes of the School of Medicine are teaching, research, 
 and the care of the sick. 
 
 To attain these there must be: 
 
 (a) An intimate geographical and functional union with a university hospital. 
 
 (b) Such limitation of numbers of students as will permit the consistent 
 pursuit of a definite policy. Increasing demands may be met by a com- 
 plete duplication of the whole unit. 
 
 (c) Reorganization of the main clinical departments on a full-time basis. 
 
 It is therefore recommended that: 
 
 (a) An organic affiliation be formed with the Presbyterian Hospital. 
 
 (b) That sufficient funds be obtained to furnish the necessary land, buildings 
 and endowment. 
 
 This plan represents the best thought of the present time but will naturally 
 be subject to such modifications and changes in future years as larger experience 
 may suggest and justify. 
 
Appendix E 
 
 Agreement between the Trustees of Columbia University and Presbyterian 
 Hospital: approved by the University on February y, 1921 and by the 
 Hospital on February 10, 1921, including revision of April ly, 1934. 
 
 This Agreement made this 10th day of February one thousand nine hun- 
 dred and twenty-one, between The Trustees of Columbia University in the 
 City of New York, a corporation organized under the laws of the State of New 
 York (hereinafter called the University), party of the first part, and the Pres- 
 byterian Hospital in the City of New York, a corporation organized under the 
 laws of the State of New York (hereinafter called the Hospital), party of the 
 second part. 
 
 For the purpose of establishing a permanent alliance between the University 
 and the Hospital (a) to secure the best obtainable treatment of the sick and 
 injured and (b) to provide for medical education and research of the highest 
 type it is mutually covenanted and agreed as follows: 
 
 article 1 
 
 The University and the Hospital is each to continue its independent existence 
 and control. Nothing in this agreement is to be construed to affect any function 
 of either the University or the Hospital not expressly covered by its terms. 
 
 article 11 
 
 The proposed new buildings of the Medical School of the University and the 
 Hospital are to be built upon an agreed site. There shall be a division of the site 
 between the University and the Hospital, and each is to acquire the portion 
 assigned to it in such division at its own cost and expense. The portion assigned 
 to the University is to be conveyed to, and be owned and maintained by, the 
 University; and the portion assigned to the Hospital is to be conveyed to, and 
 be owned and maintained by, the Hospital. 
 
 The parties are within four months from the time this agreement goes into 
 effect to proceed with the preparation of plans for the new buildings and the 
 construction of the buildings in accordance with the plans adopted and con- 
 tinue such construction with due diligence to the completion of the buildings. 
 
Appendices 139 
 
 ARTICLE III 
 
 The professional staffs of the Hospital are to consist of professors and other 
 members of the staff of the Medical School of the University who are to be 
 appointed by the Hospital on the nomination of the University. 
 
 REVISED APRIL 1 7, 1 934 TO READ AS FOLLOWS! 
 
 The professional staffs of the Hospital are to be appointed by the Hospital 
 on the nomination of the University, and are to consist of professors and other 
 members of the Staff of the Medical School of the University and of other 
 persons of comparable standing in the medical profession. 
 
 ARTICLE IV 
 
 In order that the permanent alliance of the University and the Hospital shall 
 be maintained and effectively administered, an Administrative Board is to be 
 appointed to consist of three Managers of the Hospital, and three Trustees of 
 the University, with the Dean of the Medical School acting in an advisory 
 capacity without voting power. The first Board shall consist of Edward S. 
 Harkness, Henry W. DeForest, and William Sloane, representing the Hospital, 
 and John G. Millburn, Walter B. James, and William Barclay Parsons, repre- 
 senting the University. In case of a vacancy by death, resignation or other 
 cause, it is to be filled by the body that made the appointment; but the ap- 
 pointments made by the Hospital shall be subject to the approval of the Uni- 
 versity and those made by the University shall be subject to the approval of 
 the Hospital. 
 
 ARTICLE V 
 
 The powers of the Administrative Board are to be as follows: 
 
 1 . A list of the members of the professional staffs of the University who are 
 nominated by the University to constitute the professional staffs of the Hospital 
 is to be submitted annually by the University to the Administrative Board for 
 its approval before its presentation to the Hospital for its action under Article 
 III. 
 
 2. To consider any objection made to any member of the professional staffs 
 of the Hospital, and to report thereon with their recommendations to the Uni- 
 versity and the Hospital. 
 
 3. To examine and consider plans for the new Hospital and new Medical 
 School buildings and to report thereon to the University and the Hospital with 
 their recommendations. 
 
 4. Subject to the approval of the Trustees of the University and the Board 
 of Managers of the Hospital, to determine from time to time the facilities and 
 
140 Appendices 
 
 equipment for instruction and research in the Hospital; to apportion between 
 the University and the Hospital any joint or common outlay or expenditure 
 for construction, equipment or operation that may be found necessary by the 
 mutual action of the University and the Hospital; and to exercise such other 
 powers as may be conferred upon it from time to time by the authority of the 
 Trustees of the University and the Board of Managers of the Hospital acting 
 concurrently. 
 
 REVISED APRIL 1 7, I934 TO READ AS FOLLOWS: 
 
 1. Whenever so requested by the Administrative Board, a list of the mem- 
 bers of the professional staffs of the University and other persons of comparable 
 standing in the medical profession who are nominated by the University to 
 constitute the professional staffs of the Hospital is to be submitted by the Uni- 
 versity to the Administrative Board for its approval before its presentation to 
 the Hospital for its action under Article III. 
 
 2. Unchanged 
 
 3. Unchanged 
 
 4. Unchanged 
 
 ARTICLE VI 
 
 This agreement is to continue in full force and effect until terminated by 
 the mutual consent of the parties. 
 
 This Agreement made this ioth day of February one thousand nine hun- 
 dred and twenty-one, between The Trustees of Columbia University in the 
 City of New York, a corporation organized under the laws of the State of New 
 York, hereinafter called the University, party of the first part, and the Presby- 
 terian Hospital in the City of New York, a corporation organized under the 
 laws of the State of New York, party of the second part. 
 
 Whereas the parties hereto have signed and executed an agreement of even 
 date herewith for a permanent alliance for the purpose therein stated, 
 
 Now Therefore, in consideration of the premises, it is mutually agreed by 
 and between the parties hereto that the said agreement of even date herewith 
 shall go into effect and become operative when the University shall have raised 
 a fund of not less than three million dollars ($3,000,000.) for the construction 
 of the new buildings of the Medical School of the University, to be constructed 
 by it as provided in said agreement, and shall have notified the Hospital to that 
 effect; and that if said fund shall not be raised on or before the 1st day of July, 
 1 92 1, said agreement of even date herewith shall be deemed to be abandoned 
 and annulled. 
 
Appendix F 
 
 Agreement between the Trustees of Columbia University, the Presbyterian 
 Hospital and the City of New Yor\, dated July 29, 1936. 
 
 AGREEMENT, made and dated July 29, 1936, between the Presbyterian 
 hospital in the city of new york, a New York corporation, having its prin- 
 cipal office at Broadway and 168th Street in the Borough of Manhattan, City 
 of New York, hereinafter referred to as the "Hospital," the trustees of 
 Columbia university in the city of new york, a New York corporation, 
 having its principal office at 76 William Street, in the Borough of Manhattan, 
 City of New York, hereinafter referred to as the "University" and the city 
 of new york, a municipal corporation, hereinafter referred to as the "City." 
 
 whereas, the parties hereto desire to establish and maintain a District Health 
 and Teaching Center upon property now owned by the Hospital at the south- 
 westerly corner of Broadway and 168th Street; 
 
 and whereas, a District Health and Teaching Center is, for the purposes 
 of this agreement, described and defined as follows: 
 
 A branch office of the Health Department serving a neighborhood or re- 
 gional community for all those functions which require the visit of doctor, 
 nurse or sanitary inspector to the people's homes or the call of persons of any 
 age upon its Health Department for advice, counsel, warning or specific 
 preventive and diagnostic service, particularly in the care of maternity, in- 
 fancy, childhood, the control of communicable diseases and the dissemina- 
 tion of knowledge upon the hazards to health and resources for its develop- 
 ment and protection; 
 
 Involving, among others, the following services by The Department of 
 Health through such District Health and Teaching Center: 
 
 Public Health Nursing service (communicable disease control and education), 
 
 School Medical Inspection, 
 
 Tuberculosis and other health guidance services, 
 
 X-ray and local minor laboratory service, 
 
 Pre-natal service, 
 
142 Appendices 
 
 Baby health stations, 
 Pre-school conferences, 
 Venereal disease service, 
 Health education and nutritional service, 
 Children's dental and oral hygiene service; and 
 
 Involving services by non-official voluntary agencies such as the following: 
 District visiting nurse service, 
 
 District offices of health and family welfare agencies, 
 
 Services supplementing those of the Department of Health, particularly as 
 regards: 
 
 A. Work with mothers and babies and pre-school children, 
 
 B. Educational work and health guidance; and 
 
 Involving the ability of properly accredited teachers and students of medi- 
 cine, nursing, dentistry and public health practices of the University and stu- 
 dent and graduate nurses of the Hospital to have access to such Health and 
 Teaching Center for the purpose of observation, demonstration, study and 
 teaching therein of public health and kindred practices; 
 
 and whereas the objectives to be gained by the establishment of such a 
 Health and Teaching Center are: 
 
 (1) Public Health service to residents of the District; 
 
 (2) The training of various types of professional and technical personnel 
 used by the Department of Health of the City of New York, except laboratory 
 technicians and bacteriologists, now provided for in the Bureau of Laboratories 
 of the Department of Health; 
 
 (3) The better teaching of students of medicine, nursing, dentistry and 
 public health practices, in order that they may more adequately serve the 
 needs of the community; 
 
 (4) The practical training in public health practices of student and graduate 
 nurses; 
 
 (5) The conduct of research in matters pertaining to public health; 
 
 so as to assure the most practicable application of the science and art of pre- 
 ventive medicine to the People of the Washington Heights district, and permit 
 the study of and participation in these services by the students and teachers of 
 the University through its School of Medicine, and by student and graduate 
 nurses of the Hospital through the several institutions now or which may here- 
 after be affiliated with the University and the Hospital in their present location 
 at the Medical Center; 
 
 now, therefore, in consideration of the premises and of the convenants 
 herein contained, it is mutually agreed as follows: 
 
Appendices 143 
 
 (1) The Hospital will convey to the City a vacant plot of land at the south- 
 westerly corner of Broadway and 168th Street, upon which the City is to erect 
 a building and approaches thereto to be used for such District Health and 
 Teaching Center, which plot is more particularly bounded and described as 
 follows : 
 
 beginning at the corner formed by the intersection of the westerly side of 
 Broadway with the southerly side of West 168th Street, running thence 
 westerly along the southerly side of West 168 Street 85 feet; thence southerly 
 and parallel with the westerly side of Broadway 53 feet; thence easterly and 
 parallel with the southerly side of West 168th Street 32 feet; thence southerly 
 and parallel with the westerly side of Broadway 18 feet; thence easterly and 
 parallel with the southerly side of West 168th Street 53 feet to the westerly 
 side of Broadway, and thence northerly along the westerly side of Broadway 
 71 feet to the point or place of Beginning. 
 
 Together with casements for light and air over a strip of land 10 feet in 
 width adjoining said property on the southerly and westerly lines afore- 
 mentioned, upon which said strips no building shall be erected by the Hos- 
 pital, its successors or assigns, higher than 18 feet above grade. 
 
 (2) The City will, at its own expense, erect upon such plot of land a build- 
 ing to be used for such District Health and Teaching Center and will equip 
 same for such use, including not less than 12,000 square feet therein allocated 
 to the use of the Hospital and the University as hereinafter provided, accord- 
 ing to plans and specifications which shall conform with the general architec- 
 tural plan of the buildings at the Medical Center and be subject to the ap- 
 proval in writing of the Hospital and the University and their Joint Ad- 
 ministrative Board. 
 
 Such building shall be not more than seven stories in height and shall con- 
 form in general to attached sketch plans and preliminary specifications and 
 cost analysis, and shall be completed on or before January 1, 1939. 
 
 The steel "on the job" used in the construction of such building shall be 
 bolted, not riveted. 
 
 The building so constructed shall not be enlarged, altered or extended in 
 any manner without the mutual written consent of the City and the Hospital, 
 nor shall such building contain any plant of any kind for the generating of 
 heat, electricity or power or have any chimneys or smoke stacks connected 
 therewith in any way. 
 
 (3) Such building shall be used : 
 
 A. For the purposes of and the services contemplated in a District Health 
 and Teaching Center as set forth and defined in the preambles to this agree- 
 ment. 
 
 B. For the services of and training by the City of various types of profes- 
 
144 Appendices 
 
 sional and technical personnel used by the Department of Health of the City 
 contemplated in a Health and Teaching Center as set forth and defined in the 
 preambles to this agreement, except laboratory technicians and bacteriologists 
 provided for in the Bureau of Laboratories in the Department of Health. 
 
 C. For the teaching by the University of students and graduate students of 
 medicine, nursing, dentistry and public health practices of the University and 
 students and graduate nurses of the Hospital of Public Health practices and 
 activities, as described and defined herein, and for the demonstration, observa- 
 tion and study of and participation in such activities and practices of such 
 students and nurses to include: 
 
 i. Candidates for the Degree of Doctor of Medicine 
 
 2. Graduates in medicine or science who are candidates for the graduate de- 
 grees in Public Health or in one of the sciences contributing to public 
 health 
 
 3. Candidates for the Degree of Doctor of Dental Surgery 
 
 4. Pupil and graduate nurses of the Presbyterian Hospital Teaching School 
 or any successor Hospital or University Department of Nursing 
 
 5. Graduate nurses from the Department of Nursing Education of Teachers 
 College 
 
 and for no other purposes whatever save by written mutual agreement. 
 
 (4) The City shall, at its own expense, maintain and operate said building 
 in general conformity with the standards established in the Hospital with re- 
 spect to its properties at the Medical Center, and will, at its own cost and ex- 
 pense, furnish proper heat, water, light, including electricity, illuminating gas, 
 air pressure and suction and janitorial service for said building, including the 
 space therein to be used solely by the University and the Hospital as herein- 
 after provided. 
 
 (5) The Hospital and University shall be given, without expense to them, 
 the sole use of not less than 12,000 square feet of working area in uppermost 
 portion of said building for the purposes hereinbefore referred to and shall at 
 all times, through their accredited personnel, be afforded the opportunity: 
 
 A. To observe the work carried on by the City in all parts of said Health 
 Center; 
 
 B. To demonstrate to and teach its students and nurses in the work and 
 practices carried on by the City in such Health and Teaching Center; 
 
 C. To have access to the City's records with reference to such work so far 
 as permitted by law. 
 
 (6) The privileges accorded herein to the accredited personnel of the Hos- 
 pital and the University shall be deemed, for the purposes of the agreement, to 
 include the accredited personnel of all institutions and bodies now or which 
 may hereafter be affiliated with the Hospital and/or the University. 
 
Appendices 145 
 
 (7) The property to be conveyed by the Hospital to the City shall be con- 
 veyed by a bargain and sale deed in the form hereto annexed and made a part 
 of this agreement to be delivered as soon as the plans and specifications for the 
 building are approved by the Hospital and the University and their Joint Ad- 
 ministrative Board. Such deed shall contain an express condition providing for 
 the reversion of the title to said property to the Hospital with the right to the 
 Hospital to re-enter and repossess itself of the same in the event that the City 
 shall not have constructed said building on or before January 1, 1939, and/or 
 in the event that the City shall at any time cease to use the said premises for a 
 District Health and Teaching Center as defined and described herein. 
 
 (8) In the event that the parties hereto shall disagree as to the interpretation 
 of any of the provisions contained herein, except as to the provisions relating 
 to reverter contained in Paragraph (7), or as to the rights and privileges of the 
 Hospital and University hereunder, such disagreement shall be submitted to 
 arbitration, one arbitrator to be appointed by the Hospital and the University 
 and another by the City. If such arbitrators do not agree, they shall appoint a 
 third arbitrator as umpire, the decision of such arbitrator or umpire to be final 
 and binding upon the parties hereto, the expenses of such arbitration to be 
 assessed by such arbitrators or umpire at their discretion against any or all of 
 the parties hereto. 
 
 (9) Hereto attached and made a part hereof is a set of sketch plans and an 
 analysis of the estimated costs, bearing this title "Washington Heights Health 
 and Teaching Center." 
 
Appendix G 
 
 Agreement between Presbyterian Hospital, Columbia University and the City 
 of New Yor\, dated February iy, 1941. 
 
 AGREEMENT, made and dated February 17, 1941, between the Pres- 
 byterian hospital in the city of new york, a New York corporation, 
 having its principal office at Broadway and 168th Street in the Borough of 
 Manhattan, City of New York, hereinafter referred to as the "Hospital," the 
 
 TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK, a New York 
 
 corporation, having its principal office at 76 William Street, in the Borough 
 of Manhattan, City of New York, hereinafter referred to as the "University" 
 and the city of new york, a municipal corporation, hereinafter referred to 
 as the "City," 
 
 whereas, the City desires to build and maintain a Cancer Hospital and 
 Clinic to replace the present New York City Cancer Institute on Welfare 
 Island now condemned and the Cancer Clinic now located at 124 East 59th 
 Street, frequently condemned in the past, and 
 
 whereas, it is the desire of the Department of Hospitals of the City to se- 
 cure the highest quality of medical care and treatment for patients afflicted 
 with cancer, of research into the causes and methods of therapy, and of educa- 
 tion of physicians, medical students and others in every phase of cancer by 
 establishing an affiliation with Columbia University through its Faculty of 
 Medicine under which the University would nominate the members of the 
 professional staff of such a Cancer Hospital and Clinic, except such appoint- 
 ments as are made under the rules of the Municipal Civil Service Commission 
 of the City of New York, and 
 
 whereas, the Hospital is willing to offer a site for such a Cancer Hospital 
 and Clinic at 163rd Street and Fort Washington Avenue for the purposes 
 hereinabove set forth, 
 
 now, therefore, in consideration of the premises and of the covenants 
 herein contained, it is mutually agreed as follows: 
 
 1. The Hospital will convey to the City a vacant plot of land at the corner 
 
Appendices 1 47 
 
 of 163rd Street and Fort Washington Avenue under the terms hereinafter 
 stated upon which the City is to erect a building or buildings and approaches 
 thereto to be used for a Cancer Hospital and Clinic, which plot is more par- 
 ticularly bounded and described as follows: 
 
 beginning at the corner formed by the intersection of the northerly side 
 of West 163rd Street with the westerly side of Fort Washington Avenue, 
 running thence northerly along the westerly side of Fort Washington Avenue 
 to a point distant 200 feet northerly from the northerly side of West 163rd 
 Street as measured along a line drawn at right angles thereto, running thence 
 westerly and parallel to the northerly side of West 163rd Street to the 
 easterly side of Riverside Drive, thence southerly along the easterly side of 
 Riverside Drive to the northerly side of West 163rd Street, and thence 
 easterly along the northerly side of West 163rd Street 515.30 feet to the 
 point or place of beginning. 
 
 2. The City will, at its own expense, proceed promptly to erect upon the 
 above described land a building or buildings including laboratories for research 
 to be used for such a Cancer Hospital and Clinic and will equip same for such 
 use according to plans and specifications which shall conform with the general 
 architectural plan of the buildings at the Medical Center and be subject to the 
 approval in writing of the Hospital and the University. The steel "on the job" 
 used in the construction of said building or buildings shall be bolted, not riv- 
 eted. The erection of such building or buildings shall be commenced within five 
 years from the date of the delivery of the deed as provided for in Paragraph 1 , 
 and if not so commenced the property shall be reconveyed by the City to the 
 Hospital. 
 
 No additions, extensions or alterations shall be made to said building or 
 buildings unless the plans and specifications therefor shall first have been ap- 
 proved by the Hospital and the University. 
 
 3. Such building or buildings shall be used: 
 
 A. For the purposes and the services necessary to provide care and treat- 
 ment of in-patients and out-patients with cancer or other neo-plastic 
 disease. 
 
 B. For research into the causes, prevention, and methods of diagnosis and 
 treatment of cancer. 
 
 C. For the education of physicians, medical students, dentists and others in 
 the various aspects of cancer. 
 
 4. The City shall, at its own expense, maintain and operate said building or 
 buildings in accordance with generally approved and accepted standards and 
 
148 Appendices 
 
 shall, at its own expense, furnish heat, water, light, electricity, air pressure and 
 suction, gas, power, and all facilities and services requisite for the operation and 
 maintenance of said building and laboratories for the purposes designated. 
 
 5. The City will appoint the members of the clinical and other professional 
 staff of the Cancer Hospital and Clinic upon nomination of the University, ex- 
 cept such appointments as are made under the rules of Municipal Civil Service 
 Commission of The City of New York. 
 
 6. The University, through its accredited personnel duly nominated by it 
 and appointed by the City, shall at all times be afforded the opportunity to 
 demonstrate and teach its medical students, physicians and other properly 
 qualified students and to conduct research in the wards, laboratories and out- 
 patient services of the Cancer Hospital and Clinic, subject to the rules and 
 regulations of the Department of Hospitals of the City of New York. 
 
 7. The property to be conveyed by the Hospital to the City shall be con- 
 veyed by a bargain and sale deed in the form hereto annexed and made a part 
 of this agreement to be delivered as soon as the plans and specifications for the 
 building or buildings are approved by the Hospital and the University. Such 
 deed shall contain an express condition that in the event the City shall at any 
 time, for a period of six months, fail or cease to use the said premises for a 
 Cancer Hospital and Clinic as defined and described herein and in the manner 
 and subject to the conditions stated, the City shall be obligated to compensate 
 the Hospital for the land conveyed, the amount to be decided by the arbitra- 
 tion as provided in Paragraph 8 hereof for the settlement of disagreements as 
 to the interpretation of the provisions of this contract. 
 
 8. In the event that the parties hereto shall disagree as to the interpretation 
 of any of the provisions contained herein or as to the rights and privileges of 
 the Hospital and University hereunder, such disagreement shall be submitted 
 to arbitration, one arbitrator to be appointed by the Hospital and the Uni- 
 versity and another by the City. If such arbitrators do not agree, they shall 
 appoint a third arbitrator as umpire, the decision of such arbitrator or umpire 
 to be final and binding upon the parties hereto, the expenses of such arbitra- 
 tion to be assessed by such arbitrators or umpire at their discretion against any 
 or all of the parties hereto. Any such arbitration shall be in accordance with the 
 Arbitration Law of the State of New York as the same shall be in effect at the 
 time of such arbitration. 
 
Appendix H 
 
 Agreement between Trustees of Columbia University and St. Luke's Hospital 
 dated June 2j, 194J. 
 
 AGREEMENT, made this 27th day of June, 1947, between the trustees 
 of Columbia university in the city of new york, a New York corporation 
 (hereinafter called "the University"), and ST. luke's hospital, a New York 
 corporation (hereinafter called "the Hospital"), witnesseth: 
 
 For the purpose of establishing an affiliation between the University and the 
 Hospital to provide facilities and opportunities at St. Luke's Hospital for under- 
 graduate medical education and the training of interns and hospital residents 
 on standards acceptable to the University and with the object of securing for 
 the Hospital the stimulation and professional development of the staff associ- 
 ated with the proposed educational program, the parties hereto, in considera- 
 tion of the mutual benefits to be enjoyed by such affiliation and the mutual 
 promises herein contained, hereby agree as follows: 
 
 FIRST 
 
 The University and the Hospital is each to continue its independent existence 
 and control. Nothing in this agreement is to be construed to affect anv function 
 of either the University or the Hospital not expressly covered by its terms. 
 
 second 
 
 The University will assign medical students to serve as clinical clerks in the 
 Hospital in such numbers and for such periods as may be mutually agreed upon. 
 
 The professional staff of the Hospital will provide instruction and supervised 
 training of the clinical clerks in the wards and laboratories of the Hospital in 
 keeping with the educational program of the University. 
 
 FOURTH 
 
 The Hospital, will continue as heretofore to appoint the interns on the 
 nomination of the Medical Board of the Hospital. 
 
150 Appendices 
 
 FIFTH 
 
 The Hospital will continue as heretofore to appoint the residents on the 
 nomination of the Medical Board and these residents will be considered as 
 graduate medical students for whom the Hospital and University will provide 
 advanced instruction and experience, the former in the hospital wards, op- 
 erating rooms and other hospital facilities, the University by offering oppor- 
 tunities in its scientific laboratories for specialized instruction, research and ad- 
 vanced training under its established program of graduate medical education. 
 The schedules of such residents, including possible interchange with other 
 teaching institutions affiliated with the University, will be worked out by the 
 Joint Committee for which provision is hereinafter made. 
 
 The University will appoint to academic positions and to its Faculty of 
 Medicine certain members of the Hospital's staff who are directly responsible 
 for the instructional effort in the Hospital, such appointments to be made from 
 a list of names to be forwarded by the Medical Board of the Hospital to the 
 Faculty of Medicine. 
 
 A Joint Committee of the Medical Board of the Hospital and the Faculty 
 of Medicine will be created to coordinate the joint educational effort of the 
 Hospital and the University and to make recommendations to the Hospital and 
 the University on any matters affecting the training program. 
 
 EIGHTH 
 
 The affiliation shall place no financial obligations on the University or the 
 Hospital except as either may wish to support the desired educational or pro- 
 fessional activities. 
 
 NINTH 
 
 The affiliation herein provided shall take effect on July 1, 1947, and con- 
 tinue until amended in writing or terminated. It may be terminated at the 
 end of any academic year (June 30th) upon one year's notice in writing from 
 either party to the other. 
 
Appendix I 
 
 Agreement between Trustees of Columbia University and the City of New 
 Yor\ dated March i, 1954. 
 
 AGREEMENT, made March 1, 1954, between the city of new york, a 
 municipal corporation (hereinafter referred to as "the City"), and the 
 
 TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK, (hereinafter 
 
 referred to as "the University"), witnesseth: 
 
 whereas, the City requested the University to cooperate with it in staffing 
 the Goldwater Memorial Hospital when it was constructed in order to insure 
 the highest quality of medical care and treatment of persons afflicted with 
 chronic diseases and to be responsible for the research program in the causes, 
 diagnosis and treatment of chronic diseases in that institution for which in 
 part it was built; and 
 
 whereas, the University has been conducting the research programs on the 
 Columbia University Service of that Hospital since it was constructed and in 
 cooperation with the Department of Hospitals has made noteworthy contribu- 
 tions in the advancement of knowledge in chronic disorders and disabilities, 
 thus giving to the people of the City of New York great benefit from such ad- 
 vanced knowledge and new methods of therapy; and 
 
 whereas, the conduct of active research on the University Division at the 
 Goldwater Memorial Hospital is in the best interests of the City and the sick 
 who are admitted to that Hospital; and 
 
 whereas, this type of program can be best advanced under the auspices of 
 the University and the City has already delegated to the University the right 
 of nominating the staff and of conducting the research program in chronic 
 diseases on the Columbia University Service of the Goldwater Memorial Hos- 
 pital; and 
 
 whereas, the University because of the opportunities for the advancement 
 of medical knowledge and the better care of patients with chronic diseases has 
 been able to secure substantial additional funds from foundations, individuals, 
 University sources and Federal financial aid to carry forward these programs, 
 of which the City contribution is only a small fraction of the total expendi- 
 tures for these purposes; 
 
152 Appendices 
 
 now therefore, the parties hereto, in consideration of the foregoing and of 
 the mutual promises herein contained, hereby agree as follows that: 
 
 I. The University will carry on the research and clinical program in the 
 Goldwater Memorial Hospital in a competent manner and in the best interests 
 of patients in that Hospital. 
 
 II. The City will contribute toward the cost of conducting the research pro- 
 gram in chronic diseases on the University Division at the Goldwater Me- 
 morial Hospital as follows: 
 
 (a) From March 1, 1954 to June 30, 1954, the sum of $16,666.66 
 
 (b) From July 1, 1954 to June 30, 1959, the sum of $50,000 
 
 per year, such annual payment to be made in quarterly installments com- 
 mencing on October 1, 1954, and quarterly thereafter on the first days of 
 January, April, July and October in each year during the term of this agree- 
 ment. 
 
 During the term of this agreement, the City in addition will physically 
 maintain the laboratories and their equipment and furnish all supplies neces- 
 sary for the conduct of the routine services and research activities of the labora- 
 tories. 
 
 In no event, however, shall the City be required to contribute to the Uni- 
 versity pursuant to the terms of this agreement, any monies in excess of the 
 sum of $50,000 per year as heretofore provided herein. 
 
 III. The University agrees to expend all monies received from the City, 
 pursuant to this agreement, toward the cost of operating the research labora- 
 tories and related program herein referred to. 
 
 No part of the aforesaid monies shall be used by the University to supplement 
 the salaries of civil service employees whose salaries are otherwise provided for 
 by the City. The University shall not be required to support professional or 
 scientific workers in any department or laboratory of the Hospital other than 
 those associated directly with the research program of the University Division. 
 
 IV. The University may receive and accept grants, gifts, bequests, devises 
 and contributions from any source in support of the professional, research and 
 scientific activities to be carried on in the Hospital and research investigations 
 which the University may conduct in conjunction with similar work conducted 
 elsewhere in the Medical School or other divisions of the University. 
 
 V. The University will furnish at such reasonable times as the Commissioner 
 of Hospitals may request and in such manner as he may prescribe any and all 
 information concerning its activities carried on under this agreement in the 
 Goldwater Memorial Hospital. 
 
 Not later than October 1st of each year the University will render to the 
 
Appendices 153 
 
 Commissioner of Hospitals an annual report which will contain a description 
 of the work done in the laboratories for the period covered in the report. 
 
 VI. This agreement shall become effective and binding on the parties hereto 
 when signed by the Mayor and the Commissioner of Hospitals, pursuant to 
 the authority of the Board of Estimate, and the duly authorized representative 
 of the University and shall continue for a period of five years and four months 
 thereafter. 
 
 VII. This agreement may be terminated upon six months written notice by 
 either party, or it may be modified by mutual agreement of the parties hereto. 
 
 VIII. Upon termination of this agreement 
 
 (a) the liability of the City for payment of compensation and of the Uni- 
 versity for services hereunder will cease; 
 
 (b) the University will account for and refund to the City the pro-rata por- 
 tion, as of the date of termination, of unearned compensation paid hereunder 
 as well as all other compensation received from the City which, at the time 
 of such termination, is unappropriated. 
 
 (c) the University will turn over to the City all unexpended equipment, 
 appurtenances and property purchased with City funds; and 
 
 (d) the University will make available to the City its reports, notes and 
 other information concerning the research completed by it or in the course of 
 completion hereunder. 
 
Appendix J 
 
 Agreement between Trustees of Columbia University and Presbyterian Hos- 
 pital, dated June 29, i%^. 
 
 AGREEMENT dated this 29 day of June, 1955 between the trustees 
 of Columbia university in the city of new york, a corporation organized 
 under the laws of the State of New York (hereinafter called "the University"), 
 and the Presbyterian hospital in the city of new york, a consolidated 
 corporation organized under the laws of the State of New York (hereinafter 
 called "the Hospital"): 
 
 whereas, prior to the academic year 1937—38 the Hospital and its prede- 
 cessor corporations had for many years conducted the Presbyterian Hospital 
 School of Nursing (hereinafter referred to as "the School"), and had assumed 
 the entire administrative and financial responsibility with respect thereto; and, 
 
 whereas, beginning with the academic year 1937—38, the University estab- 
 lished a Department of Nursing in its Faculty of Medicine and under an 
 agreement dated January 21, 1937 and subsequent agreements between the 
 University, the Hospital and its predecessor corporations the parties thereto 
 made various arrangements providing for the assumption by the University, 
 through said Department of Nursing, of responsibility for the educational pro- 
 gram of the School, and the coordination of nursing and nursing education by 
 the parties and for the making of certain payments by the Hospital to the 
 University for the support of said Department of Nursing; and 
 
 whereas, the University and the Hospital wish to restate in one document 
 said agreements and arrangements without affecting in any way any other 
 agreement, arrangement or undertaking between the parties: 
 
 now, therefore, the parties hereto mutually covenant and agree as follows: 
 
 1. The University shall have the responsibility for and full control of the 
 educational program in nursing at the Columbia-Presbyterian Medical Center 
 and shall conduct such a program in keeping with the standards required by 
 the University. 
 
 2. The Hospital shall have the responsibility for and full control of the nurs- 
 ing service for the care of patients in the Hospital in accordance with standards 
 
Appendices 155 
 
 and procedures established by the Medical Board of the Hospital with the ap- 
 proval of the Board of Trustees of the Hospital. 
 
 3. There shall be a Director of Nursing, who shall be both Professor and 
 Executive Officer of the Department of Nursing in the Faculty of Medicine 
 of the University and the head of the nursing service in the Hospital and who 
 shall be responsible to the University for the educational program of the School 
 and to the Hospital for the nursing service in the Hospital. The Director of 
 Nursing shall have as principal assistants (a) a Director of Nursing Education, 
 who shall have primary responsibility for the educational program of the 
 School as specified in paragraph 1 above, and (b) a Director of Nursing Service, 
 who shall have primary responsibility for the nursing care of patients in the 
 Hospital as specified in paragraph 2 above. The University shall have full con- 
 trol of the teaching program and the Hospital shall have full control of the 
 nursing care of patients in the Hospital, due regard being given to a program 
 for the student nurses which is satisfactory both from the point of view of 
 nursing education and nursing service to patients. 
 
 4. The Director of Nursing, the Director of Nursing Education and the 
 Director of Nursing Service and all other persons carrying appointments in 
 both the University and the Hospital with respect to nursing shall be nom- 
 inated by the University and appointed by the University and the Hospital 
 only after they have been first considered jointly by the Dean of the Medical 
 School and the Vice President and General Manager of the Hospital and after 
 full agreement has been reached that such persons are acceptable to both the 
 University and the Hospital. Such appointees shall at all times be completely 
 acceptable to both parties. 
 
 5. The University shall award the degree of Bachelor of Science to qualified 
 students who complete in the School the requirements for the degree as pre- 
 scribed by the University, and the Hospital shall award diplomas to such 
 graduating students of the School as have been nominated thereto by the 
 University. 
 
 6. The University agrees to submit to the Hospital at least ninety (90) days 
 before the beginning of each academic year a forecast of the University's ex- 
 penditures for the coming academic year for salaries and other expenses of the 
 School to support the program currently being financed by contributions from 
 the Hospital. The Hospital, in consideration of the assumption by the Univer- 
 sity of the responsibility for the educational program of the School agrees to 
 pay to the University during the academic year, in equal monthly installments, 
 such amounts (not less than $100,000) for each academic year as may be 
 agreed upon by the Dean of the Medical School and the Vice-President and 
 General Manager of the Hospital with the approval of the Board of Trustees 
 of the Hospital. 
 
156 Appendices 
 
 7. The Hospital agrees to provide at its expense, board and lodging for 
 students in the School in Maxwell Hall to the extent of its reasonable capacity. 
 
 8. The University agrees that the total time of students in the School de- 
 voted to nursing care of patients will not be changed without the consent of 
 the Hospital. 
 
 9. Either the University or the Hospital may terminate this Agreement as 
 of the first day of July in any year, provided that at least three years' written 
 notice of intention so to do shall have been given the other. 
 
Appendix K 
 
 Agreement between Trustees of Columbia University and Presbyterian Hos- 
 pital dated December 5, 1956. 
 
 AGREEMENT, dated December 5, 1956, between the Trustees of Co- 
 lumbia university in the city of new york, a corporation organized under 
 the laws of the State of New York (hereinafter called "the University"), and 
 the Presbyterian hospital in the city of new york, a consolidated cor- 
 poration organized under the laws of the State of New York (hereinafter 
 called "the Hospital"). 
 
 whereas, the University and a corporate predecessor of the Hospital, 
 namely, The Presbyterian Hospital in the City of New York (hereinafter called 
 "Presbyterian") entered into an agreement of permanent alliance dated Feb- 
 ruary 10, 1 921; and 
 
 whereas, Edward S. Harkness and the University and Presbyterian entered 
 into an agreement dated September 29, 1922 to express the agreements of the 
 University and Presbyterian in respect of certain property contemporaneously 
 acquired by the University and Presbyterian from Edward S. Harkness; and 
 
 whereas, the University and Presbyterian and The Babies Hospital of the 
 City of New York, a corporation organized under the laws of the State of New 
 York (hereinafter called "Babies Hospital") entered into an agreement dated 
 November 11, 1925, amending said agreement dated February 10, 1921 and 
 establishing a permanent mutual alliance between the University and Babies 
 Hospital; and 
 
 whereas, the University and Presbyterian and The Neurological Institute 
 of New York, a corporation organized under the laws of the State of New 
 York (hereinafter called "Neurological") entered into an agreement dated 
 November 27, 1925 amending said agreement dated February 10, 1921 and 
 establishing a permanent mutual alliance between the University and Neuro- 
 logical; and 
 
 whereas, said agreement dated February 10, 1921 was further amended by 
 an agreement dated April 17, 1934 and said agreements dated November 11, 
 1925 and November 27, 1925 were amended by agreements dated May 29, 
 1934; and 
 
158 Appendices 
 
 whereas, Presbyterian and Babies Hospital and Neurological were con- 
 solidated into a single corporation, namely, The Presbyterian Hospital in the 
 City of New York, pursuant to certificate of consolidation filed December 31, 
 1943, and said consolidated corporation and New York Orthopaedic Dispen- 
 sary and Hospital were consolidated into a single corporation, namely, the 
 Hospital, pursuant to certificate of consolidation filed October 1, 1945; and 
 
 whereas, the Hospital has succeeded to the rights and obligations of Pres- 
 byterian, Babies Hospital and Neurological under said agreements dated Feb- 
 ruary 10, 1 921, September 29, 1922, November 11, 1925, November 27, 1925, 
 April 17, 1934 and May 29, 1934; and 
 
 whereas, the University and the Hospital wish to provide further for their 
 alliance, to carry out the purposes expressed in the agreements heretofore 
 entered into between them and the ideals of Edward S. Harkness whose gener- 
 osity made possible the development of the Medical Centre, to secure the best 
 obtainable treatment of the sick and injured and to provide for medical educa- 
 tion and research of the highest type; and to these ends, the University and the 
 Hospital wish to amend and restate in one document the provisions of said 
 agreements dated February 10, 1921, November n, 1925, November 27, 1925, 
 April 17, 1934 and May 29, 1934; 
 
 now, therefore, said agreements dated February 10, 1921, November 11, 
 1925, November 27, 1925, April 17, 1934 and May 29, 1934 are hereby amended 
 and restated, and the University and the Hospital mutually covenant and 
 agree; as follows: 
 
 article one 
 
 The University and the Hospital are each to continue their independent 
 existence and control. Nothing in this Agreement is to be construed to affect 
 any function of either the University or the Hospital not expressly covered by 
 its terms. 
 
 ARTICLE TWO 
 
 In order that the permanent alliance between the University and the Hos- 
 pital shall be maintained and effectively administered, there shall be a Joint 
 Administrative Board which, on and after January 1, 1957, shall consist of eight 
 members, namely, the President and three other Trustees of the University to 
 be named by the University and the President and three other Trustees of the 
 Hospital to be named by the Hospital. This Board shall succeed the Joint Ad- 
 ministrative Board constituted pursuant to the aforementioned agreements re- 
 ferred to in the preambles hereto. 
 
 Any vacancy among the representatives of the University shall be filled by 
 
Appendices 159 
 
 the University and any vacancy among the representatives of the Hospital shall 
 be filled by the Hospital. 
 
 ARTICLE THREE 
 
 The Joint Administrative Board shall have the following powers and duties: 
 
 (a) Subject to the approval of the Trustees of the University and the Trus- 
 tees of the Hospital when separate corporate action is necessary, to determine 
 activities and operations to be undertaken jointly by the University and the 
 Hospital, to determine the means of implementing and obtaining support 
 therefor, and to determine the allocation of income and expenses in connec- 
 tion therewith, including any expense for construction or equipment. 
 
 (b) To appoint a Secretary of the Joint Administrative Board who shall be 
 the executive officer of the Board. The salary and expenses of the Secretary 
 of the Joint Administrative Board and of his staff shall be paid one-half by 
 the University and one-half by the Hospital. 
 
 (c) To discharge the duties and functions required to be performed by the 
 Joint Administrative Board as set forth in the agreement dated September 
 29, 1922, between Edward S. Harkness and the University and Presbyterian. 
 
 (d) To consider all other matters affecting the alliance between the Univer- 
 sity and the Hospital and to report thereon with recommendations to the 
 University and the Hospital and to exercise such powers as may be con- 
 ferred upon it from time to time by the Trustees of the University and the 
 Trustees of the Hospital acting concurrently. 
 
 ARTICLE FOUR 
 
 The professional staffs of the Hospital are to be appointed by the Hospital 
 on the nomination of the University and are to consist of professors and other 
 members of the staff of the University Medical School and of persons of com- 
 parable professional standing. 
 
 ARTICLE FIVE 
 
 For all purposes of the agreement dated September 29, 1922, between Ed- 
 ward S. Harkness and the University and Presbyterian (a) Parcel H. shall in- 
 clude both the land owned by the Hospital at the date hereof which was 
 originally included in said Parcel H. including the land conveyed by Presby- 
 terian to Babies Hospital by indenture dated November 11, 1925, and the land 
 owned by the Hospital at the date hereof which was originally included in 
 Parcel U, including the land conveyed by the University to Neurological by 
 indenture dated November 27, 1925 and the land conveyed by the University 
 to Presbyterian by indenture dated May 29, 1931, and (b) improvements paid 
 
160 Appendices 
 
 for by the Hospital shall include all improvements paid for by Presbyterian, 
 Babies Hospital and Neurological. 
 
 article six 
 
 This Agreement is binding upon the successors and assigns of the parties 
 hereto and is to continue in full force and effect until terminated by mutual 
 consent. 
 
Appendix L 
 
 ADMINISTRATIVE OFFICERS OF THE FACULTY OF MEDICINE 
 
 Deans 
 
 Samuel W. Lambert 
 William Darrach 
 
 WlLLARD C. RaPPLEYE 
 
 1904-1919 
 
 1919-1930 
 
 1931-1958 
 
 Assistant Deans and Associate Deans 
 
 Sidney R. Burnap 
 Frederic T. van Beuren 
 Edward P. Cathcart 
 Raymond B. Allen 
 
 Charles A. Flood 
 Lawrence W. Sloan 
 
 Vernon W. Lippard 
 
 Aura E. Severinghaus 
 
 George H. Humphreys II 
 
 Bion R. East 
 Margaret E. Conrad 
 Harry S. Mustard 
 John B. Truslow 
 
 Associate Dean 
 Associate Dean 
 Associate Dean 
 Associate Dean 
 
 (Graduate Studies) 
 Assistant Dean 
 Assistant Dean 
 
 (Graduate Studies) 
 Assistant Dean 
 Associate Dean 
 Assistant Dean 
 Associate Dean 
 Assistant Dean 
 
 (Postgraduate Studies in 
 
 Medicine) 
 Associate Dean 
 
 (Dental and Oral Surgery) 
 Associate Dean 
 
 (Nursing) 
 Associate Dean 
 
 (Public Health) 
 Assistant Dean 
 
 (Graduate Studies) 
 
 1919-1921 
 1921-1934 
 
 i 934~ I 935 
 r 934- J 936 
 
 I 93 6 ~ I 939 
 J 937- J 939 
 
 1939-1941 
 
 1942-1946 
 1942-1944 
 1945-present 
 1 944-1 945 
 
 1945-1949 
 1945-1950 
 1945-1949 
 1946-1950 
 
1 62 
 
 Harold W. Brown 
 
 Maurice J. Hickey 
 
 James E. McCormack 
 
 Ray E. Trussell 
 
 Gilbert P. Smith 
 
 Richard J. Cross 
 Eleanor Lee 
 
 Appendices 
 
 Acting Associate Dean 
 
 (Public Health) 
 Associate Dean 
 
 (Public Health) 
 Acting Associate Dean 
 
 (Dental and Oral Surgery) 
 Associate Dean 
 
 (Dental and Oral Surgery) 
 Associate Dean 
 
 (Graduate Studies) 
 Associate Dean 
 
 (Public Health) 
 Associate Dean 
 
 (Dental and Oral Surgery) 
 Assistant Dean 
 Associate Dean 
 
 (Nursing) 
 
 1947-1950 
 
 i95 1_I 955 
 
 1948-1949 
 
 1949-1956 
 
 I 95 I ~ I 955 
 
 1955-present 
 
 1956-present 
 
 1957-present 
 beginning 
 July 1, 1958 
 
 Executive Officers of Departments 
 
 ANATOMY 
 
 George S. Huntington 1 890-1924 
 Samuel R. Detwiler 1927-1957 
 
 Wilfred M. Copenhaver 1957-present 
 (Acting) 
 
 anesthesiology 
 Emanuel M. Papper 
 
 1952-present 
 
 biochemistry 
 
 William J. Gies 
 Hans T. Clarke 
 David Rittenberg 
 
 1905-1928 
 1928-1956 
 1956-present 
 
 dental and oral surgery 
 
 Bion R. East 
 Maurice J. Hickey 
 Gilbert P. Smith 
 
 1945-1949 
 1949-1956 
 1956-present 
 
Appendices 
 
 163 
 
 DERMATOLOGY 
 
 John A. Fordyce 
 J. Gardner Hopkins 
 A. Benson Cannon 
 Carl T. Nelson 
 
 19 17-1925 
 1926-1947 
 1947-1950 
 1 95 1 -present 
 
 MEDICINE 
 
 Theodore C. Janeway 
 Warfield Longcope 
 Walter W. Palmer 
 Robert F. Loeb 
 
 1909-1914 
 1914-1921 
 1921-1947 
 1947-present 
 
 MICROBIOLOGY 
 
 Philip H. Hiss, Jr. 
 Hans Zinsser 
 Frederick P. Gay 
 A. Raymond Dochez 
 Beatrice Seegal 
 
 (Acting) 
 Harry M. Rose 
 
 (Acting) 
 Harry M. Rose 
 
 1906-1913 
 19 1 5-1922 
 
 I 9 2 3 _I 939 
 
 1940-1948 
 
 1949-1950 
 1951-1952 
 1952-present 
 
 NEUROLOGICAL SURGERY 
 
 J. Lawrence Pool 1949-present 
 
 neurology 
 
 Frederick Tilney 
 Walter W. Palmer 
 Tracy J. Putnam 
 H. Houston Merritt 
 
 1915-1938 
 1938-1941 
 1941-1947 
 1948-present 
 
 NURSING 
 
 Margaret E. Conrad 
 Eleanor Lee 
 
 (Acting) 
 Eleanor Lee 
 
 I 937~i95o 
 1951-1954 
 
 1955-present 
 
164 
 
 Appendices 
 
 OBSTETRICS AND GYNECOLOGY 
 
 Edwin B. Craigin 
 William E. Studdiford 
 Benjamin P. Watson 
 Howard C. Taylor, Jr. 
 
 1899-1918 
 1919-1925 
 1 926-1 946 
 1946-present 
 
 ophthalmology 
 
 Arnold Knapp 
 John M. Wheeler 
 Phillips Thygeson 
 John H. Dunnington 
 
 1918-1928 
 1 928-1939 
 1 939-1 945 
 1946-present 
 
 ORTHOPEDIC surgery 
 
 Russell A. Hibbs 1918-1932 
 
 Benjamin P. Farrell 1934-1940 
 
 Alan DeForest Smith 1 940-1 956 
 
 Frank Stinchfield 1956-present 
 
 OTOLARYNGOLOGY 
 
 Cornelius G. Coakley 
 John B. Kernan 
 Edmund P. Fowler, Jr. 
 
 1917-1934 
 
 I 935- I 947 
 1 947-p resent 
 
 pathology 
 
 William G. MacCallum 191 4-1 9 17 
 James W. Jobling 191 8-1944 
 
 Harry P. Smith 1945-present 
 
 PEDIATRICS 
 
 L. Emmett Holt 
 Herbert B. Wilcox 
 Rustin McIntosh 
 
 1902-1922 
 I 922- I 930 
 1 930-p resent 
 
 PHARMACOLOGY 
 
 Charles C. Lieb 
 Harry B. van Dyke 
 
 1929-1943 
 1944-present 
 
Appendices 
 
 165 
 
 PHYSICAL MEDICINE AND 
 REHABILITATION 
 
 Robert C. Darling 1952-present 
 
 PHYSIOLOGY 
 
 Frederick S. Lee 
 Frank H. Pike 
 Horatio B. Williams 
 Magnus I. Gregersen 
 
 1911-1920 
 1 920-1 92 1 
 1922-1937 
 1937-present 
 
 PSYCHIATRY 
 
 Thomas W. Salmon 
 George H. Kirby 
 Clarence O. Cheney 
 Nolan D. C. Lewis 
 Lawrence C. Kolb 
 
 1923-1927 
 i927- J 933 
 i933- J 93 6 
 i93 6 - r 953 
 1954-present 
 
 public health 
 
 Haven Emerson 
 Harry S. Mustard 
 Harold W. Brown 
 
 (Acting) 
 Harold W. Brown 
 Ray E. Trussell 
 
 1925-1940 
 1 940-1 949 
 1947-1950 
 
 1951-1955 
 1955-present 
 
 RADIOLOGY 
 
 Ross Golden 
 Harold W. Jacox 
 William B. Seaman 
 
 I 934~ I 954 
 1954-1956 
 1956-present 
 
 SURGERY 
 
 George E. Brewer 1913-1917 
 
 Adrian V. S. Lambert 1917-1921 
 Allen O. Whipple 1921-1946 
 
 George H. Humphreys II 1946-present 
 
 UROLOGY 
 
 }. Bentley Squier 
 George F. Cahill 
 John K. Lattimer 
 
 1917-1939 
 
 1 939-1 955 
 1955-present 
 
COLUMBIA UNIVERSITY LIBRARIES 
 
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 provided by the library rules or by special arrangement with 
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