Letter on the Future Location of 
 
 the College of Physicians and Surgeons. 
 
 
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[confidential 
 
 Columliia ^nitietgitp 
 in tije Citp of i^eto gork 
 
 A LETTER 
 
 ON THE 
 
 FUTURE LOCATION OF THE COLLEGE OF 
 
 PHYSICIANS AND SURGEONS AND 
 
 THE UNIVERSITY HOSPITAL 
 
 BY ' 
 
 FREDERIC S: LEE, Ph.D. 
 
 Dalton Professor of Physiology 
 AND 
 
 FRANK H. PIKE, Ph.D. 
 
 Assistant Professor of Physiology 
 
'^■^C—(^/f 
 
 
Columbia ®nitiers;itp 
 
 in tfje Citj) of i^eto gorfe 
 
 Columbia University, 
 
 April 9, 1913- 
 
 Nicholas Murray Butler, LL.D., President, 
 
 Dear Sir: The alliance of Columbia University and the 
 Presbyterian Hospital and the consideration of plans for the 
 organization and building of the hospital have brought promi- 
 nently into the foreground the whole subject of the future of the 
 Columbia School of Medicine. As members of the teaching 
 staffs of medicine and pure science, we are much interested in 
 the general subject and its discussion, and believing that it has 
 not yet been viewed in all its aspects, we beg to present the 
 following considerations. 
 
 Most of the schools of medicine in this country have begun 
 their existence as independent proprietary institutions. As such 
 they naturally acquired the habit of formulating and solving 
 their own problems. In the course of time, however, and under 
 the influence of both American and German universities, they 
 have come to realize that entire independence is not the ideal 
 condition and they have sought or accepted university connec- 
 tions, a relation which has existed in Italy for several centuries. 
 In some cases these connections are nominal; in others the 
 schools have become integral parts of the universities. But how- 
 ever intimate such connections may be, there are few schools if 
 any that have wholly resigned their independent habits and ac- 
 cepted university ideals to the extent that schools of pure science, 
 law and political science have accepted them. In other words, 
 American medical schools have not yet come to realize what a 
 university affiliation really means. Nor on the other hand have 
 universities fully appreciated their duties to their adopted 
 children. 
 
This Is the situation in Columbia. In the discussion of the 
 problems of the future of the Columbia School of Medicine 
 stress has been laid heretofore almost exclu- 
 Medical School, sively upon the school and the hospital in their 
 Hospital and mutual relations. It seems to have been over- 
 University looked that three elements are involved : the 
 medical school, the hospital, and the rest of 
 the university. But if the ideal of development is to be attained 
 all of these elements must be taken into account : the functions of 
 the medical school are not properly limited to itself and the 
 hospital, nor are those of the university limited to itself and the 
 school; the university neither does its whole duty nor receives 
 its whole benefit by simply lending the weight of its authority 
 to an adjustment of relations between the two other institutions. 
 A medical school of the broad type ought not to exist alone for 
 the training of young men to be doctors, — it falls short of one 
 of its highest functions if it does not serve as a means of train- 
 ing men of science. A hospital of the broad type ought not to 
 exist alone for the immediate care and possible cure of the sick, 
 — a higher function is the scientific study of diseased organisms 
 and the discovery of means, better than now exist, of maintain- 
 ing organisms in a condition of health. A university ought to 
 inspire both medical school and hospital with its largeness of 
 view, and in turn it should receive from both a new conception 
 of the breadth of its opportunities for culture. 
 
 It is customary to classify the various branches of study with 
 which a medical school has to deal into the medical sciences, 
 which include anatomy, histology, embryology, physiology, 
 physiological chemistry, pathology, bacteriology and pharma- 
 cology; and the clinical subjects, which com- 
 Medical prise medicine and surgery not only in their 
 
 Sciences and general aspects but in their many subdivisions 
 
 Clinical Sub- or specialties. In the customary division of 
 
 jects the time of the medical student's four years, 
 
 the medical sciences are usually allotted the 
 first two years, or nearly the whole of them, and the clinical 
 subjects the last two years. The position of the medical sciences 
 
 2 
 
in the university at the present time is peculiar. Many of them 
 were born and have passed through their periods of infancy and 
 adolescence in the protecting arms of medicine. They have 
 thus acquired ineradicable medical relations. But they are now 
 mature and have gone far beyond medical boundaries; while 
 their medical relations still exist and are of great importance 
 both to themselves and to medicine, medicine is no longer their 
 chief sphere. This is eminently true of anatomy, histology, em- 
 bryology, physiology and physiological chemistry, which have 
 broadly biological affiliations far transcending their medical 
 bearings. The same is true, though in slightly less degree, of 
 bacteriology; while of pathology and pharmacology, though 
 their general biological relations are still less obvious, these 
 exist and are bound to become more prominent as time goes on. 
 For the purposes of the school of medicine all of these sciences 
 are medical sciences; for the purposes of the rest of the univer- 
 sity they are both medical and pure sciences. The departments 
 to which they belong thus have a two-fold educational function 
 to perform in the university : they must provide instruction both 
 in applied science to students of medicine and, unless their ex- 
 pensive equipments are to be duplicated, in pure science to stu- 
 dents of science. It is sometimes difficult for men of medicine 
 to realize that the medical sciences are no longer preeminently 
 medical In their relations, and by many clinicians they are merely 
 tolerated In the medical school as affording a supposedly neces- 
 sary preparation for, but as strictly subordinate to, the real 
 business of medical life. While their followers are expected to 
 engage In scientific research as well as to teach, their Investiga- 
 tions are expected to be more or less "practical" In that they 
 should have some immediate relation to clinical medicine. This 
 is a wholly anomalous condition. It is, however, plain that the 
 position of the so-called medical sciences In the university Is dif- 
 ferent from that of the clinical subjects. The proper status of 
 the former ought to be recognized by the university, and they 
 should be given opportunities for broad development. This 
 should be given due weight in solving the problem of the 
 location of the future school of medicine of Columbia. 
 
There are various localities in which the future school of 
 medicine may conceivably be housed. It may remain indefi- 
 nitely, without a hospital, in West 59th 
 Possible Loca- Street; the medical sciences, with the excep- 
 tions of Medical tion of pathology, may remain in 59th Street 
 School or may be removed to Morningside Heights 
 
 in case medicine, surgery and pathology are 
 removed, as has been suggested, to the proposed new Presby- 
 terian Hospital on the East River; the entire school may be 
 located at the site of the Presbyterian Hospital on the East 
 River; the entire school and an adequate hospital may be situ- 
 ated, as was once contemplated, at Morningside Heights. 
 These possibihties may now be considered seriatim. 
 
 First. The school of medicine may remain indefinitely, 
 without a hospital, in West 3gth Street. This proposition need 
 not detain us. The obvious facts that the 
 Continuation of school has outgrown its present buildings and 
 School in 59th that it requires a hospital for its proper future 
 Street development, are sufficient reasons for the 
 
 termination of the present conditions and re- 
 moval to a new site. Even the acquisition of the Roosevelt 
 Hospital, long regarded as a possibility, would not properly 
 solve the problem. Our reasons for this opinion may be learned 
 by a perusal of the discussion of the third and fourth proposi- 
 tions, for the points there raised apply with almost equal force 
 to a continuance of the school, with a hospital alliance, in 59th St. 
 Second. The medical sciences, with the exception of pa- 
 thology, may remain in SQth Street, or may he removed to 
 Morningside Heights in case medicine, sur- 
 Separation of gery and pathology are removed, as has been 
 Medical Sci- suggested, to the proposed new Presbyterian 
 
 ences from Hospital on the East River. This proposi- 
 
 Clinical Sub- tion deserves serious consideration, for it in- 
 
 jects volves a fundamental change of policy on the 
 
 part of the university, namely: the geographi- 
 cal separation of the medical sciences and the clinical subjects 
 and a complete change of academic residence of the student of 
 
 4 
 
medicine in the middle of his four years. In various American 
 universities such a condition exists, notably at Bowdoin, Cali- 
 fornia, Chicago, Indiana, Kansas, Leland Stanford, Mississippi 
 and Nebraska. In all of these institutions the instruction of 
 the whole, or nearly the whole, of the first two years is given at 
 the main site of the universities, while the clinical work is per- 
 formed at the more or less distant medical schools. The same 
 is true in part for Cornell University, since some of its students 
 are allowed to take their first two years at Ithaca, while all stu- 
 dents must take the final two years in New York. Moreover, 
 the medical schools of Wake Forest, and the universities of 
 Missouri, North Carolina, South Dakota, Utah, West Virginia 
 and Wisconsin are so-called half schools, offering instruction in 
 the medical sciences only and obliging their graduates to seek 
 clinical Instruction in other institutions. 
 
 The effects of such geographical separation may be consid- 
 ered from the point of view, first, of the students and, secondly, 
 of the faculty. 
 
 If the first two years of the course are to be spent in physical 
 separation of the student from both the university and the site of 
 the clinical instruction, there is little If any- 
 Separation thing to be said in favor of the plan. It is 
 
 from Point of thoroughly bad. If the first two years are 
 View of spent in a reputable university, certain advan- 
 
 Students tages from the point of view of the student 
 
 of those years are possible. Such a plan 
 would mean an added two years' contact with the university be- 
 yond the preparatory two years of college work which all the 
 better medical schools of the country now require. These added 
 years would tend to give the student a broader view of science 
 and would imbue him more thoroughly with academic ideals- 
 He would mingle not only with his fellow medical students, but 
 with others who would be studying the same subjects because of 
 their academic Interest without reference to their future appli- 
 cation in a technical career, and such Intercourse, if these latter 
 associates were serious scientific students, would afford a distinct 
 advantage. The student of medicine would have his time free 
 
for the study of the laboratory subjects without behig tempted 
 to attend medical and surgical clinics and experience the thrill 
 of procedures which he could not comprehend. He would be 
 urged to acquire a broad knowledge of his subjects, so that he 
 might have a basis for their more rational application when he 
 undertook clinical work. The amount of such knowledge which 
 is susceptible of clinical application Is of course very much 
 greater than the student's capacity of acquisition in two years. 
 Nevertheless, he would be far removed from the notion that 
 everything he learned must have some Immediate application in 
 clinical medicine or surgery without the intervention of further 
 mental processes. 
 
 But whatever advantages from association with the university 
 might accrue to the student of the first two years, the effect of 
 geographical separation from the university upon the student of 
 the third and fourth years would be distinctly disadvantageous. 
 Cut off from communication with the laboratories and the lab- 
 oratory workers of the earlier period and subjected to a purely 
 clinical atmosphere, he would be in great danger of acquiring 
 the mental narrowness which too often characterizes the grad- 
 uates of the purely technical school. Too often the main fear 
 of the purely technical school is that the art, rather than the 
 science, may be lost. This fear is especially likely to arise in 
 the mind of the Isolated medical student, and for Columbia de- 
 liberately to Isolate its medical students for the last two years 
 from all except the purely clinical environment, would be 
 equivalent to saying to those students that they were entitled 
 only to whatever prestige might accrue to them from associa- 
 tion with the name of the university, but that the benefits aris- 
 ing from the closest possible association with the best that the 
 university has to offer should be denied to them, except at the 
 cost of much time and great labor. 
 
 In considering the question of physical separation from the 
 point of view of the faculty, we may Inquire into the relations 
 of those members of the faculty who represent the medical 
 sciences, both to the representatives of the other sciences of the 
 university and to the clinical instructors. 
 
 6 
 
The instructors In the medical sciences constitute a body of 
 men who are devoted partly to the discovery and the teaching of 
 the facts and principles of pure science, and 
 Separation partly to the application of such facts and 
 
 from Point of principles. In physiology, as an example, the 
 View of chief task of the investigator is the explanation 
 
 Faculty of the processes in living matter on the basis 
 
 of known facts in physics and chemistry. The 
 nature of matter and the structure of the carbon atom are not of 
 primary interest to him as subjects for investigation, but are of 
 interest as a basis for the explanation of the deportment of liv- 
 ing matter. The progress of physiological science in certain di- 
 rections is limited by the state of advancement in the fundamen- 
 tal physical sciences. The closest contact with physicists and 
 chemists is necessary if the physiologist is to keep his ideas clear 
 with reference to developments in these sciences. Without such 
 clarity of fundamental ideas, no proper or correct extension of 
 them to the phenomena of living matter is possible. Again, the 
 physiologist may search for new relationships of the parts of the 
 organism to each other, or of organisms to their environment. 
 All this knowledge may tend toward the enlightenment of the 
 clinician, affording him a better basis for the explanation of 
 diseased conditions and occasionally suggesting a means of treat- 
 ment. The laboratory worker may also desire to test his ex- 
 perimental results, obtained for the most part from the study of 
 animals, by the observation of human patients, and to this ex- 
 tent he becomes a worker in applied science. 
 
 The clinician is, or should be, the chief worker in the applica- 
 tion of experimental types and methods to diseased conditions. 
 From the nature of his occupation, he is more or less completely 
 excluded from the pursuit of pure science and is dependent upon 
 the laboratory worker for his knowledge of the fundamental 
 facts without which their clinical application is impossible. 
 Thus intelligent or rational progress in clinical medicine is de- 
 pendent upon progress in the experimental medical sciences. 
 The clinician who prides himself upon being thoroughly prac- 
 tical often thinks he has attained his goal when he is able to 
 
 7 
 
diagnose the conditions existing in his patients and to prescribe 
 for them according to the accepted methods of the day. But if 
 the restoration of the patient to health be the standard by which 
 the practicability of the results is judged, the high death 
 rate in early life and the frequent occurrence of incurable dis- 
 ease testify to the inefficiency of existing clinical methods and 
 compel the reluctant admission that the so-called practical 
 medicine of to-day is grossly impractical. The really practical 
 man in any line of human endeavor is he who is able not only 
 to do things as well as any one else, but to apply his theoretical 
 knowledge in the development of new methods and the acquisi- 
 tion of new results in his particular field. The great body of 
 scientific knowledge acquired by laboratory workers constantly 
 affords discerning clinicians points capable of practical applica- 
 tion. The more thoughtful clinicians, indeed, are now seeking 
 the laboratory in ever increasing numbers. The real problem 
 of the man of medicine — the successful treatment of diseased 
 conditions and the restoration of the patient to health — is one 
 of surpassing difficulty. In the development of preventive 
 medicine has there been the greatest and most uniform 
 success, and here knowledge of the biology of the disease-pro- 
 ducing agents gained from a laboratory study has clearly been 
 Indispensable. The growing tendency of clinicians to return to 
 the laboratory Indicates a recognition by them of the kind of 
 knowledge that is of most worth in the really constructive work 
 of the practitioner of medicine. 
 
 With the growth of the laboratory subjects and the refine- 
 ment of laboratory methods of examination, the clinician's ca- 
 pacity for assimilation becomes exceeded, and even now the fre- 
 quent necessity Is upon us of the examination of patients by 
 trained workers not primarily clinicians, who have acquired 
 skill and knowledge of their subjects by long and careful labora- 
 tory study. This necessity will steadily increase in the future, 
 and must be met if medicine Is to attain Its highest usefulness as 
 a curative art. 
 
 Thus contact with laboratory workers Is a sine qua non for 
 the modern clinician, twice removed as he Is from the funda- 
 
mental sciences. The laboratory worker on the other hand 
 may survive without actual contact with human patients, al- 
 though his efficiency will be impaired; but the progress of medi- 
 cine will surely be impeded by the physical separation of the two 
 clinical years from the two laboratory years, or the indifference 
 of the clinician to progress in the laboratory subjects, which is 
 likely to grow out of such a physical separation. In short, the 
 physical separation of the laboratory and clinical years is an al- 
 most impassable barrier to clinical progress. 
 
 Other considerations based on any scheme that involves the 
 geographical separation of the medical sciences and the other 
 scientific departments of the university will be presented under 
 the third and fourth propositions below. 
 
 Third. The entire school of medicine may be located at the 
 site of the Presbyterian Hospital on the East River. The one 
 great advantage to the medical school of this 
 Hospital Alii- location at the site of the Presbyterian Hos- 
 ance not Ideal pital would be that the school would thus ob- 
 tain for its exclusive use an adequate hospital. 
 But the existing union of the university with the hospital is 
 merely an alliance, and not an amalgamation. When two sepa- 
 rate corporations exist and the personnel of the governing board 
 of each is distinct from that of the other, it is inevitable that 
 even with the best of intentions serious differences of opinion as 
 Jtoi policy and procedure will arise. Such an association is far 
 from ideal. The ideal relation can only be one in which the 
 university is able to exercise absolute control in the administra- 
 tion of the hospital, and it is this ideal relation alone to which 
 the university ought to look forward. 
 
 In advocacy of the site on the East River emphasis has often 
 been laid on the advantages that would accrue to the school 
 
 ,, ,. , ^ , , from proximity to the Rockefeller Institute. 
 Medical School t^t i v i > i i 
 
 , _. , ^ „ VVe believe that these supposed advantages 
 and Rockefeller . , _, ^f f 
 
 ^ . are over-estimated. 1 here is no reason to be- 
 
 lieve that the school could ever form an al- 
 liance of any kind with or obtain any special privileges from 
 the institute. A certain amount of helpfulness doubtless 
 
 9 
 
would come to the investigators in the school from associa- 
 tion with their fellow investigators in the next block. But 
 the two groups, both working in scientific medicine, would be in 
 a certain sense rivals, if only unconsciously so; and it is a ques- 
 tion whether the prestige of the institute as a purely research 
 institution would not overshadow that of the school and place 
 it in a position of inferiority and dependency. 
 
 In his "Memorandum on the Ideal Development of Hospital 
 and Medical School," Dean Lambert has presented three ob- 
 jections to the proposed site on the East 
 Dean Lam- River, namely: (i) "The present com.para- 
 
 bert's Objec- tive inaccessibility of this East River site both 
 tions for patients and for the friends and patrons 
 
 who are the sources of the hospital's financial 
 support" — an objection the weight of which has not been sufii- 
 clently appreciated and which there is no reason to believe would 
 ever be removed; (2) the new site of the Presbyterian Hospital 
 "is not in its present limited ambulance district and it has no 
 guarantee of having any ambulance service at all," — a serious 
 objection; (3) the existing restrictions against the erection of a 
 building suflSIcIently high to satisfy the needs of the future hos- 
 pital, and the impossibility of securing land north of the site 
 except at a prohibitive cost. These three objections have not 
 yet been satisfactorily answered. 
 
 We can foresee one lamentable result which would, we be- 
 lieve, inevitably follow from the removal of the entire medical 
 school to the East River site. We have 
 Medical Sci- pointed out that the so-called medical sci- 
 
 ences and ences, while medical for the purposes of medi- 
 
 School of Pure cine, are at the same time pure sciences for the 
 Science rest of the university. In accordance with 
 
 this latter aspect the departments represent- 
 ing them provide Instruction and opportunities for research for 
 graduates in the School of Pure Science who are studying to- 
 ward the degrees of A.M. and Ph.D. This is true of anatomy, 
 physiology, physiological cTiemlstry, pathology, bacteriology 
 and pharmacology. Most of the students working along these 
 
 10 
 
purely scientific lines give a portion of their time to other scien- 
 tific work at Morningside Heights. The distance between 59th 
 Street and 11 6th Street has always proved a serious obstacle to 
 this cooperative work and has cut off from the great opportuni- 
 ties presented in the one place a body of young men whose pri- 
 mary interests lie in the sciences represented in the other. Thus, 
 students in zoology may wish to take certain courses in anatomy 
 or physiology or physiological chemistry, or vice versa ; students 
 in physiology certain courses in physics or psychology, or vice 
 versa ; students in botany certain courses in bacteriology, or vice 
 versa. The present distance of three miles separating the re- 
 spective schools has often proved the decisive factor in nullify- 
 ing the student's desires. This has constantly been a source of 
 complaint, and there has been a constant wish on the part of the 
 instructors in the science departments at Morningside Heights 
 for a closer proximity of the laboratories of the medical sci- 
 ences. Evidence of this wish is presented in a subsequent por- 
 tion of the present communication. The removal of these lab- 
 oratories to the East River site would make cooperation still 
 more difficult, and would probably put an end to the ambitions 
 of the departments of the medical sciences toward an honorable 
 standing in the school of pure science. From the time of re- 
 moval anatomy, physiology, physiological chemistry, pathology, 
 bacteriology and pharmacology would stand for naught in the 
 scientific councils of the university. This would be seriously 
 detrimental not only to the best interests of the departments im- 
 mediately concerned, both those in the medical school and those 
 at 1 1 6th Street, but to the university as a whole. It is not pos- 
 sible for us to look with complacence upon such a destruction of 
 our hopes of seeing these departments university departments 
 in something more than name. They ought to be In a position 
 to share In directing the scientific policies of the university and 
 not be merely appendages to clinical medicine. 
 
 That, however. If removed to the East River, they with the 
 exception of pathology, would be little more than appendages 
 to clinical medicine Is evident from the plan of organization of 
 the new Presbyterian Hospital on university lines which has been 
 
 II 
 
proposed by a committee appointed for this purpose. This com- 
 mittee, consisting of Dean Lambert and Professors Blake, Jane- 
 way, MacCallum and Longcope, representing 
 Organization of the departments of medicine, surgery and 
 Presbyterian pathology, presented a report dated March 
 
 Hospital 29, 19 1 2, in which was outlined an elaborate 
 
 plan of organization. This plan pertains 
 to "the physical conditions which will exist during the con- 
 tinuance of the school, together with the Sloane Hospital 
 and the Vanderbilt Clinic, at its present location," and 
 from the standpoint of routine clinical medicine, surgery and 
 pathology leaves little to be desired. If, however, it represents 
 substantially the plan of the ultimate university hospital beside 
 which the school Is to be situated, it has defects which from the 
 standpoint of the university departments of the medical sciences 
 are most serious, for none of these departments, with the ex- 
 ception of pathology, Is given any real standing in the hospital. 
 The plan does permit. It is true, that "the professors of chemis- 
 try and bacteriology should become respectively consulting 
 chemist and consulting bacteriologist to the hospital; and if they 
 so desire may have facilities for carrying on investigation in 
 conjunction with the director of the medical or surgical clinic" 
 — a plan which recognizes the departments In question only in 
 the most formal way and treats them as accessory, not essential, 
 parts of the hospital scheme. The entire omission of the other 
 scientific departments Is most striking In the case of physiology. 
 The plan provides for separate physiological laboratories and 
 an assistant physician In charge of physiological work. This 
 officer is to be nominated after consultation with the head of the 
 department of physiology of the College, and may also hold a 
 position in that department, but must give his entire time to the 
 hospital and must be responsible to his superiors in the depart- 
 ment of medicine only. Not only Is It not proposed to make use 
 of the rich resources of the department of physiology, which 
 must in the nature of the case always surpass the physiological 
 resources of the department of medicine, but there is no pro- 
 vision by which the former department Is allowed access to the 
 
 12 
 
many interesting cases in the hospital, which will constantly 
 supply invaluable topics of research. Physiological science is 
 coming more and more to need human beings for observation, 
 and as the medical school is now situated in 59th Street, the 
 Vanderbilt Clinic and Roosevelt Hospital provide for the de- 
 partment of physiology abundant cases for one important va- 
 riety of human observation, namely, electrocardiographic 
 study. According to the new plan, this supply of patients 
 would be cut off, and this important phase of the work of 
 the department, for which one of the most complete equipments 
 of apparatus existing in any laboratory of the world has been 
 provided, would be seriously crippled. The necessity for the 
 cooperation of the clinical and laboratory staffs is well shown 
 also in the study of cases of nervous and mental disease. The 
 problem of localization of function is one of the most important 
 lines of work on the nervous system at the present time. The 
 approach to the problem lies through the various fields of anat- 
 omy, comparative and embryological, psychology, both animal 
 and human, physiological experimentation on all forms of ani- 
 mals, and the study of the action of drugs on the central ner- 
 vous system. It is self-evident that the acquisition of a work- 
 ing knowledge of all these subjects lies beyond the mental ca- 
 pacity of any one man. That a clinician is not prepared to diag- 
 nose and treat a case of nervous or mental disease in the best 
 possible way without the aid of investigators in all these lines of 
 work is equally apparent. 
 
 Any plan which does not allow the close cooperation of the 
 university departments of the medical sciences and the clinical 
 work of the hospital is not in accord with the 
 Organization of practice of certain of the most enlightened 
 Other modern hospitals. Thus in the city of Cleve- 
 
 Hospitals land, the director of the H. K. Gushing Lab- 
 
 oratory of Experimental Medicine of the 
 Western Reserve University, who is one of the leading Ameri- 
 can physiologists, has a regular official position on the staff of 
 the Lakeside Hospital, has the right of access to the wards, and 
 is constantly engaged in legitimate physiological research on the 
 
 13 
 
hospital patients. The Peter Bent Brigham Hospital of Bos- 
 ton, which is closely affiliated with the Harvard Medical School, 
 represents the latest phase of hospital construction and admin- 
 istration. "The entire relation between the Hospital and the 
 Medical School," writes Dr. Henry A. Christian, the physician- 
 in-chief of the Hospital, "is one of mutual cooperation, each 
 reahzing the value of the one to the other." Not only have the 
 present heads of the departments of pathology and biochemistry 
 of the Medical School been appointed as consulting pathologist 
 and chemist of the Hospital, but the head of the department of 
 physiology has become consulting physiologist, and "presum- 
 ably the professor of pharmacology when he is appointed in 
 the School will hold a similar relation." Dr. Harvey Gushing, 
 the surgeon-in-chief of the Hospital writes of the university 
 representatives of the medical sciences : 
 
 "I should myself be glad to see these men have posts exactly 
 equivalent to those commonly held by the pathologist, and also 
 to receive salaries and to have their residents like the rest of us. 
 Anything to bring the school and clinic near together — this is 
 what we should like to see brought about." 
 
 Of the nature of the hospital position. Dr. Christian writes 
 as follows: 
 
 "Dr. Cannon in his position as consulting physiologist is a 
 member of the Hospital Staff, and it is our wish that he should 
 have general oversight of the routine physiological methods of 
 studying patients. He is not to receive a salary for his work, 
 but in our general plan of organization it was provided that in 
 case this work should so develop as to require any considerable 
 amount of his time, salary provision should be made for it. It 
 has been our hope that Dr. Cannon would make occasional 
 rounds in the wards with the visiting staff to keep in touch with 
 the type of patients and to make suggestions in regard to their 
 investigation from the physiological point of view. Of course 
 he will have freedom to conduct physiological investigations 
 upon patients himself or indirectly through his assistants. Such 
 hmitations upon such work as seem needed from the clinical 
 viewpoint naturally will be placed by the physician-in-chief, 
 who is responsible for the health and treatment of all patients." 
 
 14 
 
It is thus obvious that in the Brigham Hospital the 
 cooperation of the departments of the medical sciences of the 
 Harvard Medical School is fully sought, and these departments 
 are given certain hospital rights and not mere favors. The en- 
 lightened university hospitals of the future will undoubtedly 
 recognize that the university departments of the medical sci- 
 ences, by reason both of the more accurate and extensive knowl- 
 edge of the subject matter possessed by the members of their 
 staffs and of their vastly superior laboratory facilities, are the 
 proper directors of such phases of the hospital work as come 
 properly within the pale of the sciences involved. 
 
 Fourth. The entire school of medicine and an adequate 
 hospital may be situated, as was once contemplated, at Morning- 
 side Heights. 
 
 This fourth proposition makes what is, to our minds, the 
 ideal disposition of the school of medicine. 
 
 Tradition is always hard to kill, and medical tradition is 
 especially so. It would be possible to cite Innumerable examples 
 of the persistence of medical notions long 
 Medical Educa- after they have ceased to have a vital bearing 
 tion an Educa- upon medicine itself. So, too, there is no edu- 
 tional Problem cational institution existing that is more bur- 
 dened by the weight of tradition than is the 
 medical school. In his sagacious introduction to Mr. Flexner's 
 Report to the Carnegie Foundation for the Advancement of 
 Teaching on Medical Education in Europe, President Pritchett 
 says: "Medical education Is first of all an educational, rather 
 than a professional, problem. . . . This distinction is an Impor- 
 tant one, for professional education, particularly in America, has 
 suffered from the notion that to train a man for his profession, 
 one must have the viewpoint of the practitioner only, and not 
 the viewpoint of the teacher as well. . . . The education of a 
 physician Is primarily an educational, not a medical question, 
 just as the training of an engineer Is primarily an educational, 
 not an engineering question." In the past, and especially In 
 America, medical schools almost without exception have been or- 
 ganized and administered by practitioners of medicine, while 
 
 15 
 
by far the most of the Instruction has been given by practition- 
 ers. But the omnipotence of the practitioner is already waning. 
 It has become a cardinal principle of the best schools that the 
 departments of the medical sciences should be administered and 
 the instruction therein should be given chiefly by men who are 
 not medical practitioners, and In many cases such men have 
 neither had a clinical training nor received a medical degree. 
 And the movement has now begun to put the clinical subjects 
 likewise in the hands of men who shall not practice their profes- 
 sion outside the university hospital. President Pritchett again 
 says : 
 
 "It has come to be generally conceded that not only must the 
 basic sciences of chemistry, physics, and biology be taught by 
 those who are primarily teachers and who give their whole time 
 to teaching and to research, but also that the more definitely 
 medical sciences of anatomy, physiology, pathology, and bac- 
 teriology must be represented by specialists. It has not been so 
 generally granted that the clinical teacher must also be primarily 
 a man who devotes his life to teaching and to research. This 
 reform Is the next great step to be taken In the Improvement of 
 medical education in the United States and Great Britain. In 
 Germany only has it heretofore found recognition, and to this 
 fact, next to the development of an orderly and efficient system 
 of secondary schools, is to be attributed the high level of Ger- 
 man medical science and medical teaching." 
 
 Thus Is one tradition already well-nigh broken. 
 
 Another tradition has decreed that a medical school shall be 
 located In the midst of poverty and a congested population, 
 where clinical opportunities are abundant, and 
 Medical School not too far removed from the private offices 
 and Congested of the practitioner professors. With a large 
 Population portion of the teaching staff non-practltloners, 
 
 the location of the private offices of practi- 
 tioners need no longer be of moment. The tradition of the im- 
 mediate necessity of a congested population cannot endure much 
 longer. The experience of the Vanderbilt Clinic and other 
 clinics in this city proves that ambulant patients will travel dis- 
 tances of even many miles to secure the best medical and sur- 
 
 i6 
 
gical treatment, provided that facilities for inexpensive public 
 transit exist. Mr. Flexner points out that in Germany the fame 
 of the medical professor is a powerful magnet and one of the 
 important factors in building up clinics in small university towns 
 by drawing from surrounding regions. Thus, the clinic of 
 Gottingen with a municipal population of 34,081 possesses 458 
 beds; that of Greifswald with 23,767 inhabitants has 478 beds; 
 that of Marburg with 20,136 inhabitants has 664 beds; and 
 that of Tubingen with 16,809 inhabitants has 881 beds. Krehl's 
 clinic at Heidelberg is, or was until within a very few years, the 
 largest medical clinic conducted by a single individual in the 
 world. All these facts go to show that even the poor, prone as 
 they are to follow charlatanism and ostentatious display of the 
 machinery of the healing art, will go to the famous clinics if any 
 are available. 
 
 Thus in locating the ideal school of medicine of the future, 
 other than the traditional reasons ought to be decisive. We are 
 convinced that the controlling factor should be the location of 
 the rest of the university — where the rest of the university is 
 situated, there should be its school of medicine and its hospital. 
 
 The two functions of the medical school are teaching and re- 
 search. In the minds of many laymen and even of many medi- 
 cal men the function of teaching should be 
 Teaching and preeminent In the school: it Is merely a tech- 
 Research nical school existing for the purpose of train- 
 ing practitioners of medicine and surgery. 
 And by both laymen and many medical men the success of a fol- 
 lower of medicine Is often measured by the extent of his prac- 
 tice or the fame of his success in diagnosing or treating disease. 
 Many persons are prone to dwell upon certain dramatic mo- 
 ments in the operating theater as the crowning glory of a sur- 
 geon's Hfe. It Is obvious that the need for properly trained 
 practitioners will continue to exist, and the medical school is and 
 must remain In many respects a technical school, where the 
 teaching of things as they are is carried on. But medicine that 
 Is associated solely with the conventional hospital ward and the 
 operating room or the private practice may be, and too often is, 
 
 17 
 
a merely static thing. The medical school that merely teaches is 
 but half developed. A function as great as, or perhaps even 
 greater than, teaching and more useful to mankind is research. 
 When one contemplates the success and the just fame of the 
 medical faculty of a German university one thinks immediately 
 of its contributions to scientific medicine, and one realizes that 
 because of its spirit of investigation it is enabled to educate bet- 
 ter practitioners than a mere teaching body. The medical school 
 that represents the ideal is undoubtedly one in which teaching 
 and research are coordinately developed and in which practi- 
 tioners and investigators aliUe are trained. Within such a 
 school teaching and research should not be separated as between 
 departments. Research should no more be limited to the medi- 
 cal sciences than should the clinical subjects be limited to teach- 
 ing. Each department should be a teaching and an investigat- 
 ing center. In the College of Physicians and Surgeons research 
 at present is limited chiefly to the medical sciences, in all of 
 which abundant and worthy research is being carried on. Un- 
 der the stimulating influence of the present heads of the depart- 
 ments of practice of medicine and surgery there has been a 
 gratifying development of the research spirit among a few 
 members of the staffs of those departments. In the other clini- 
 cal subjects research is largely wanting. 
 
 But teaching and research are the proper functions of every 
 school of a university and of every department within a school. 
 
 No distinction can or ought to be made in this 
 Benefits of As- respect between the medical school and the 
 sociation of rest of the university. It goes without saying 
 
 Medical School that the ideal environment for an institution 
 and University devoted to teaching and research is that of 
 
 other institutions of like function. Academic 
 isolation invariably results in narrowness and infertility. It has 
 thus become customary to associate geographically as closely as 
 possible the component schools of a university, and thus to make 
 possible the intimate association of the men who perform its 
 great functions. Such' intimate association is one of the most 
 important features in the work of a university, for it breeds a 
 
 i8 . 
 
constant interchange of ideas, a broadening of knowledge, a 
 stimulating inspiration, and an encouragement of effort. More- 
 over, it allows those departments of knowledge which have 
 ideas in common or whose fields of labor come into mutual con- 
 tact, opportunities to gain from one another. Of the various 
 subjects within a medical school anatomy, histology, and em- 
 bryology will always profit from a close association with 
 zoology; physiology with chemistry, physics, zoology, botany 
 and psychology; physiological chemistry with chemistry, zo- 
 ology and botany; bacteriology with botany; neurology and 
 psychiatry with psychology; while general medicine has points 
 of contact with all of these divisions of knowledge and more. 
 Indeed it is difficult to think of any department of medicine, 
 whether scientific or clinical, that cannot conceivably gain by 
 contact with a modern university. The immediate propinquity 
 of a university therefore cannot fail to be stimulating and up- 
 lifting and broadening to a school of medicine. But the bene- 
 fits of association are not to be limited to the school of medicine, 
 for it is capable of giving as well as receiving. 
 
 These benefits of association have been well presented by Pro- 
 fessor Paulsen in his chapter on "The unity of the university," 
 being a part of his book on "The German universities and uni- 
 versity study." He says: 
 
 "It is important, in the first place, that the teachers of all the 
 faculties should be organized into a homogeneous body. By this 
 means, the mere outward environment gives one a daily impres- 
 sion of the unity of the sciences; the daily meeting is an incen- 
 tive to seek encouragement and assistance in intellectual inter- 
 course. . . . The philosopher cOmes into constant contact with 
 students of nature and history; they mutually Influence one an- 
 other. . . . The jurist, also, comes into daily contact with the 
 historian or the economist, and the physician with the physicist, 
 the chemist and biologist; the mere presence of those others is 
 a challenge to^ look beyond the limits of his own science and to 
 make comparisons. 
 
 "It ought also to be kept In mind how frequently the tran- 
 sition Is made from one science to another, not infrequently even 
 with a total disregard of the faculty boundaries : Lotze the phi- 
 losopher was a physician and decent of medicine at Leipzig 
 
 19 
 
before he was called to the chair of philosophy at Gottingen; 
 Wundt also began with medicine, and Fechner was a lifelong 
 professor of physics; Helmholtz, physicist and physiologist, had 
 completed his medical course and was a military surgeon before 
 he became a professor of physiology and then of physics. . . . 
 All these men, moreover, laid the foundation for such dual ca- 
 pacity during their university course. 
 
 "This leads to the further observation that this intercourse 
 of the faculties is of no less significance to the students than to 
 the teachers. It is true that the university does not possess the 
 unity of a school, It is merely an association of independent 
 higher schools whose courses are in a general way coordinate. 
 There is, however, a great deal of overlapping. A German stu- 
 dent certainly will not readily leave his university without havn 
 ing heard lectures outside of his own faculty, at least without 
 having done so occasionally. . . . The unity of the university 
 by inviting the Inspection of other departments makes It pos- 
 sible to recognize and correct mistakes In the choice of courses 
 and professions before It Is too late. . . . Thus the unity of 
 university education contributes. In a high degree, to Impart to 
 the academically educated classes the feeling of unity and soli- 
 darity, the feeling of an aristocracy of Intellect, an aristocracy 
 which can hold Its own against both birth and wealth. Exclud- 
 ing no one who has the ability to secure admission to the aca- 
 demic world, the university, as formerly the clergy, represents 
 both the unity and the Intellectual leadership of the people. . . . 
 Isolated professional schools have no Individual college spirit, 
 the society is too limited, the point of view too narrow, and de- 
 pendency too great; only at a university can there be that de- 
 velopment of Ideas In common which, as the soul of the corpora- 
 tion, gives It the distinctive character and the self-preservative 
 Instinct of an organism." 
 
 The great German clinician, Friedrlch Miiller, professor of 
 medicine In Munich, In an address on the study of medicine In 
 Germany before the Frele Studentenschaft In Munich on May 
 8, 1912, said: 
 
 "V/e wish the medical student to grow up within the uni- 
 versity in active Intellectual and social contact with the students 
 of other faculties, and to receive incentive from all sides. We 
 wish for him an opportunity to hear other lectures, to pursue 
 other studies than those of his narrow field, and to develop into 
 a man of general culture. A physician ought not to be narrow- 
 
 20 
 
minded; he ought to take his social position among the cultured 
 men of the nation." 
 
 In order that our conviction of the benefits of intimate asso- 
 ciation between the school of medicine and the rest of the uni- 
 versity may not appear to be limited to our- 
 Views of Medi- selves alone, we have asked the opinion of a 
 cal Leaders of very few of the leaders in scientific medicine 
 Great Britain in England and America, and have permission 
 to quote them here. 
 Dr. C. S. Sherrington, Holt professor of physiology In the 
 University of Liverpool, and one of the foremost British leaders 
 In the medical sciences, writes as follows : 
 
 "The question It [our letter] asks regarding the relative ad- 
 vantages to a school of medicine of having close propinquity to 
 the rest of the university of which It Is a part seems to me to 
 admit of a very clear answer. If one regards the school In its 
 aspect as a place for the scientific study of disease with a view 
 to the instruction of students and to the furthering of knowl- 
 edge by research and discovery, the school undoubtedly benefits 
 greatly from the opportunities for close contact with the other 
 scientific schools of the university, both those of the pure sci- 
 ences and those of the applied, but quite especially the former. 
 This Is surely the meaning of the advent of a new era In medi- 
 cine when a university pure chemist (Pasteur) stepped over his 
 chair's frontiers, in the Interests of medicine; or, to take surgery, 
 when Lister turned to following Pasteur's biochemical w^ork 
 with a view to improving his own ward-results. 
 
 "Also, may we not feel that a school of medicine in its turn 
 will contribute something to the breadth and earnestness with 
 which Its sister schools of study proceed In the university, If by 
 daily Intercourse with them through Its staff and students its 
 own aims and difficulties and sympathies are known and recog- 
 nized to be not ungermane to the rest? 
 
 "Further, I have myself long been convinced that one of the 
 first duties of every university, and quite especially of every 
 large university, is to leave no means unused for bringing to- 
 gether In their work as well as In their play all sorts and condi- 
 tions of their students. It is. In my opinion, of the highest good 
 to a student that he should have mixed with students outside as 
 well as within his own particular 'Fach.' It gives breadth of 
 character as well as breadth of knowledge. Only by providing 
 
 21 
 
free mutual contact between its students of medicine, law, di- 
 vinity, pure science, engineering, teaching, and what not, can 
 university life ensure on the average that distinction and cath- 
 olicity of judgment and sympathy for others which must be 
 recognized as one of the best gifts which a successful university 
 bestows on its alumni — the acquisition of a broad understand- 
 ing and kindly though critical respect for the aims of their fel- 
 low men and women. 
 
 "As to the importance to physiology of its work being done 
 alongside of that of the other natural sciences, especially physics 
 and chemistry and biology, that is too obvious to need mention. 
 To me it appears an absolute essential for the prosperity of any 
 physiology school. Without it physiology has always lan- 
 guished and become 'dry-as-dust.' " 
 
 Dr. W. H. Gaskell, lecturer in physiology in the University 
 of Cambridge, a man of many years' experience within univer- 
 sity circles, a member of the Moseley Commission, and one who 
 possesses a broad outlook over educational problems, writes : 
 
 [The place of physiology in the university] "Is in the scien- 
 tific department alongside of the chemical, physical and biologi- 
 cal laboratories. The same reasoning applies to a less degree 
 to all the scientific departments connected with medicine, such 
 as anatomy, pathology and pharmacology. For workers in all 
 these departments It Is, to my mind, of Incalculable value that 
 the so-called non-medical laboratories should be close at hand so 
 that at any moment they may obtain the best advice from ex- 
 perts in these departments. There Is not, in my opinion, the 
 same absolute necessity that the hospital Itself should be In such 
 close proximity to the scientific schools of the university, though 
 I look upon such proximity as the Ideal for a medical school, 
 provided that the situation of the university does not preclude 
 the attainment by the hospital of the best clinical teaching. . . . 
 Of course if the circumstances are such that the best clinical 
 teaching — both with respect to the supply of patients and the 
 quality of the staff — be obtained in a hospital situated close to 
 the scientific laboratories, then In my opinion you have the ideal 
 school." 
 
 Dr. J. S. Haldane, reader In physiology In the University of 
 Oxford and fellow of New College, a keen observer and 
 thinker, writes : 
 
 22 
 
"On the abstract question as to whether it is desirable that 
 the medical school should be close to the other university build- 
 ings if at all possible, my own opinion is a very decided one, 
 that the advantage of such juxtaposition is very great. The 
 medical sciences are every year becoming more directly depen- 
 dent upon physics, chemistry and biology, and for this reason it 
 seems clear that the medical school ought not to be separated 
 off from these subjects. I also think that there are still broader 
 educational grounds for keeping the study of medicine in con- 
 tact as far as practicable with other university studies, includ- 
 ing literary ones. From the experience of this university, I 
 should say that it is certainly good for the university as a whole 
 that the men studying different subjects should be in contact 
 with one another as far as possible and that a broader and 
 sounder education is obtained under these circumstances." 
 
 Dr. Benjamin Moore, Johnston professor of biochemistry 
 in the University of Liverpool, an active investigator in medi- 
 cal science, an acute thinker in medical problems, who speaks 
 from the background of an experience as professor in the Char- 
 ing Cross Hospital Medical School, the Yale Medical School, 
 and for many years at Liverpool, writes : 
 
 "I have no hesitation in saying that both your medical school 
 and your hospital will suffer by being cut off from the university 
 geographically — the school very obviously; the hospital less ob- 
 viously so, but none the less seriously. Nothing has kept back 
 the progress of practical medical sciences in your country 
 and mine so much as clinical professors in the university becom- 
 ing purely professional practitioners and commercial men in- 
 stead of remaining as scientific inquirers. A university hospital 
 attached to a medical school is something more than a charitable 
 institution for attending on the sick poor; it is an institution de- 
 voted to humanity for discovering the causes and means of pre- 
 vention of disease. Unfortunately, money and commercialism 
 enter in and physicians and surgeons become 'dollar hunters' in 
 your country, and 'guinea grubs' in mine with a few honorable 
 and notable exceptions. The atmosphere of a university is the 
 corrective for this, and you lose this if both hospital and medical 
 school are not kept in close living contact with all the other 
 broad faculties of the university. Compare Germany with our 
 countries in this respect, and observe how the physician or sur- 
 geon there works for love of his subject and professional fame, 
 
 23 
 
the most distinguished men being often found in small cities, 
 but with world-famed university clinics. If you want to replace 
 the God of Gold by the God of Learning, you must set up your 
 dwelling near the university temple. As to physiology and bio- 
 chemistry, it is quite obvious that these must gain by daily con- 
 tact with their colleagues in biology and chemistry. In addi- 
 tion, there is the broadening influence that comes from meeting 
 men in other faculties altogether than medicine and science. If 
 there is to be a soul kept in science, we must mix with philosoph- 
 ers and artists and scholars, or we shall turn into mechanics and 
 technicians and will be incapable in the end of any real prog- 
 ress." 
 
 Dr. Lewellys F. Barker, professor of medicine in Johns 
 Hopkins Medical School, physician-in-chief 
 Views of Amer- of the Johns Hopkins Hospital, acknowl- 
 ican Medical edged as one of the broad-minded American 
 
 Leaders leaders both in scientific medicine and in prob- 
 
 lems of medical education, writes : 
 
 "Wherever such propinquity is possible and practically feas- 
 ible, the advantages are numerous. For the advance of medi- 
 cine it is highly desirable that the subjects of the first two years 
 of medicine shall be taught as science departments of a great 
 university In close connection with the research work of the 
 graduate school. It is most helpful to the professors of anat- 
 omy, physiology, pharmacology, pathology and Internal medi- 
 cine to have easy opportunity of contact with the professors of 
 physics, chemistry, biology and psychology. Moreover, It is 
 highly desirable for the practical work of a hospital and for the 
 clinical instruction of a hospital, that the laboratory department 
 of the medical school be situated near by. The workers in the 
 more practical department should be able without difficulty fre- 
 quently to consult the workers In the more strictly theoretical 
 branches. When the work of the primary branches and of the 
 sciences fundamental thereto is too far removed from the work 
 of the chnlcal branches, both parts suffer. The theoretical basal 
 sciences need the Influence of the practical branches, and vice 
 versa. Of course the problem of chnlcal material has to be con- 
 sidered, but with the rapid transit facIHtles which now exist, in- 
 cluding motor ambulances, etc., the problem has in recent years 
 assumed a new phase." 
 
 24 
 
Dr. David L. Edsall, professor of practice in the Plarvard 
 Medical School, a representative of the best type of modern 
 medical science, who held a professor's chair for several years 
 at the Medical School of the University of Pennsylvania, be- 
 fore being called to Harvard, writes: 
 
 "It is distinctly desirable to have the medical school of a uni- 
 versity in direct contact with the university proper, geographi- 
 cally as well as otherwise. With any medical school, however, 
 I think, in order especially to keep the clinical staff at its best in 
 efficiency and productiveness, in order also to increase the pro- 
 ductiveness and proficiency of the scientific (medical) depart- 
 ments, and especially in order that the students be properly 
 trained in the relations between the scientific and clinical sides 
 of medicine, the first desideratum is that the hospital facilities 
 mainly used by the school be immediately adjacent to the medi- 
 cal science departments. If this can be done on the grounds of 
 the university proper, it is the best arrangement by far. ... I 
 would separate from good hospital connections, however, in 
 order to get into immediate contact with the general university 
 if assured of the rapid provision of adequate hospital facilities 
 on the same grounds." 
 
 Professor R. R. Bensley, professor of anatomy in the Uni- 
 versity of Chicago, a medical man whose attention for many 
 years past has been directed to the problem of the place of the 
 laboratory subjects of the medical course in the general curric- 
 ulum of the university, writes : 
 
 "The physical separation of the medical school from the uni- 
 versity, which is, unfortunately, the situation of most of our 
 medical schools, requires a classification of the fundamental 
 sciences into medical and non-medical, which is at once arbi- 
 trary, illogical and wasteful: arbitrary and illogical because it 
 separates subjects, such as anatomy and zoology, or chemistry 
 and biochemistry, which are really parts of the same general 
 scientific group, and those which are contiguous and mutually 
 dependent fields of inquiry, such as psychology and neurology; 
 wasteful, because it requires the expensive duplication of depart- 
 ments to insure that neither the medical school on the one hand, 
 nor the university on the other, may suffer. ... It must be 
 borne in mind that the medical school will bring much to the 
 university as well as receive benefit from the university. Bac- 
 
 25 
 
teriology Is as important to botany as to medicine. Hygiene Is 
 as much a part of a broad general education as of a medical 
 education. Anatomy, physiology, and pathology have won 
 their place as general undergraduate scientific studies in those 
 institutions which have been able to offer opportunities for study 
 in these departments In the undergraduate work. The recent 
 work on serum reactions and on the nature of immunity has as 
 much bearing on general biological science as on the prevention 
 of disease. These sciences flourish best in an environment which 
 gives them at once the support of the cHnlcal faculties which are 
 dependent on them, and that of the general body of scientific 
 workers of the Institution, on whose work they are in turn de- 
 pendent." 
 
 Dr. George E. Shambaugh, assistant professor of laryngol- 
 ogy and otology In Rush Medical College, which is affiliated 
 with the University of Chicago, one of the few American prac- 
 titioners of his specialty who has spent much time in the labora- 
 tory in the scientific study of the fundamental problems of otol- 
 ogy, writes : 
 
 "I am strongly of the opinion that for those universities which 
 are planning to develop a real university department of medi- 
 cine, the entire medical school should be developed in proximity 
 to the remainder of the university. If the ideals of university 
 Instruction where 'scientific investigation is to be a prominent 
 feature' are to dominate the clinical Instruction in medicine as 
 they already do the fundamental sciences In our leading medical 
 schools, then the inspiration and assistance that will come 
 through the geographical union with other great scientific de- 
 partments of the university cannot be overestimated. On the 
 other hand, the gain to such university departments as physi- 
 ology, psychology and pathology by proximity to teaching re- 
 search hospitals will, of course, be very great. 
 
 "There are still those, especially in clinical medicine, who are 
 not able to admit that the introduction of university methods 
 and ideals In the teaching of clinical medicine Is an advantage 
 over the methods and ideals existing in our proprietary medical 
 schools. These men are anxious to have the detached medical 
 school called the university department of medicine, but they 
 oppose the Introduction of those methods and ideals which 
 alone can make It a bona fide university department of medicine. 
 
 "The most serious barrier to the development in this country 
 of a university department of medicine from the existing type of 
 
 26 
 
medical school is the geographical separation of the medical 
 school from the remainder of the university." 
 
 Dr. Joseph L. Miller, associate professor of medicine in 
 Rush Medical College, editor of the Archives of Internal Medi- 
 cine, and a physician of high clinical attainments, writes : 
 
 "It seems to me highly important that the university, the medi- 
 cal school and the university hospital be on the same ground. First 
 of all, It is going to permit of any student who wishes to do any 
 Investigation In the laboratories while studying medicine to be 
 able to carry this out without a great deal of waste of time. I 
 believe many of our medical students have the time and inclina- 
 tion to continue to do some advanced work In fundamental 
 branches, we will say physiology, during their medical years, 
 provided proper facilities are offered, and I believe this arrange- 
 ment of all the buildings on the same ground would be an im- 
 portant factor and facilitate work of this sort. Furthermore, 
 it permits a better Interchange of ideas and a closer acquaintance- 
 ship of the man in the medical department and the pure scien- 
 tist. Finally, to my mind one of the most important factors is, 
 that a university like Columbia would give a certain atmosphere 
 to the school, provided it was adjacent to it, which would be a 
 considerable factor in inspiring the clinical man to do a higher 
 class of scientific work. . . . Any other arrangement It seems 
 to me must be considered more or less as a makeshift guided 
 probably by purely financial reasons or inability to obtain a 
 site." 
 
 Dr. Joseph A. Capps, associate professor of medicine In Rush 
 Medical College, whose large experience as a consulting phy- 
 sician has qualified him to speak of the training of a clinician, 
 writes : 
 
 "I can declare myself emphatically in favor of such a com- 
 bination [the medical school and hospital with the rest of the 
 university] on several grounds. First, economically, there is a 
 tremendous saving by uniting the first years of the medical 
 school with the science department of the university. Unless 
 some very great objection exists to the teaching of medical stu- 
 dents of the first two years In the university proper. It would 
 seem to be the greatest waste and extravagance to duplicate the 
 buildings, equipment, and teachers In the scientific department 
 of the university and medical school. Secondly,' the effect on 
 
 27 
 
the university teachers, I think, is on the whole beneficial. The 
 mere teaching of the routine subjects in the first two years of 
 the medical school may not in itself be of any special advantage 
 to the teachers, but contact with the teachers of medicine and 
 with medical problems is bound to suggest good problems for 
 investigative work. In the third place, the effect upon the 
 teachers in the medical school of working in the university is 
 unquestioned. The medical teachers are bound to benefit tre- 
 mendously from daily contact with university men who are 
 working in the sciences. The association of the teachers of 
 practical medicine with the teachers of science is also most help- 
 ful in promoting the study of the border line problems, which 
 require the combined work of the laboratory and the bedside. 
 Finally, students themselves must derive benefit throughout 
 their medical course in the close association of scientific teaching 
 with that of the practice of medicine. Such an association will 
 develop more research workers than could be developed by a 
 separation of university and school." 
 
 Dr. George N. Stewart, professor of experimental medi- 
 cine and director of the H. K. Gushing Laboratory for Experi- 
 mental Medicine, of Western Reserve university, a man who 
 possesses a keen vision Into the applications of physiology to the 
 problems of clinical medicine, writes : 
 
 "I think there Is only one answer to the question propounded. 
 Mutual gain, I should say, Is not only probable but certain to re- 
 sult from bringing the medical school, including the hospital, 
 Into close topographical contact with the rest of the university. 
 Of the advantages to the university, I shall not presume to 
 speak. But the measure of the gain to the medical school can 
 probably be estimated by none so well as those who, like the 
 present writer, have suffered and are daily suffering from the 
 disadvantages of physical separation. A while ago these dis- 
 advantages were not so obvious. Medicine, at least as studied, 
 taught and practised In the average school and hospital, had 
 few points of contact with the various disciplines of the aca- 
 demic, particularly of the scientific, departments. The profes- 
 sors and students of the academic departments were still less 
 aware that medicine held anything of interest for healthy human 
 beings. All that Is changed to-day, and those who are about to 
 build should remember that the change is still going on and will 
 be even more obvious to-morrow. The science of medicine Is 
 
 28 
 
now recognized by its most enlightened and successful culti- 
 vators and more and more by the educated lay public as a branch 
 of biology, whose progress is absolutely bound up with the 
 progress of chemistry and physics, of animal and plant mor- 
 phology and physiology, and which has important relations to 
 psychology and even to sociology and political economy. And 
 it is perfectly understood that the chemistry and physics which 
 avail for the progress of medicine must be the best and freshest 
 output of the laboratories and not an inferior grade ground 
 down fine for easy assimilation by hard-worked practitioners 
 and none the worse for being a little out of date. The physi- 
 ologists, the pharmacologists, the pathologists, the wide awake 
 and progressive clinicians of the hospital should therefore be so 
 near the physicists and chemists, yes and so near the mathema- 
 ticians and the psychologists for that matter, that far from hav- 
 ing to make a special effort, to cancel engagements and travel 
 several miles, in order to meet an academic colleague whose aid, 
 perhaps entailing only a five-minute interview, may be invaluable 
 to them, and invaluable at a particular moment, they may have 
 every chance of stumbling against him on the campus, or even 
 in a fit of fruitful abstraction wandering into his laboratory in- 
 stead of their own. 
 
 "It is unnecessary to labor this point. There are many ways 
 in which physical propinquity will help the different departments 
 to tone each other up. The greater accessibility of the libraries, 
 and the more intimate contact with the business organization of 
 the university which would be brought about by the location of 
 the medical school on the university campus are very consider- 
 able advantages in my opinion. I will end by saying that the 
 above conclusions, although I think they could be deduced by 
 general reasoning from the abstract proposition which you sub- 
 mitted, are, so far as I am concerned, the fruit of a not incon- 
 siderable experience with both arrangements." 
 
 Dr. J. Gordon Wilson, professor of otology in the North- 
 western University Medical School, one of the best representa- 
 tives of the scientific investigator, who sees the broad bearings 
 of his medical specialty, writes : 
 
 "I received my medical education at a school where the medi- 
 cal department with its hospitals was immediately adjacent to 
 the other university departments. I spent several years in a 
 university where the university proper and the first two years of 
 medical studies were in one campus, while the hospitals with the 
 
 29 
 
last two years were several miles away. I am now In a fully 
 equipped medical school situated at a considerable distance from 
 the university proper with the departments of chemistry, physics 
 and psychology. 
 
 "My experience has led me to recognize the great advantage 
 of a close association of the medical school with the scientific 
 faculties of the university. The cooperation of Investigators In 
 medicine with scientific Investigators in other fields is becoming 
 every day of more Importance. 
 
 "To the teacher and especially the investigator In the medical 
 faculty, the wider views to be obtained by the close intercourse 
 with members of the scientific groups are of the utmost impor- 
 tance. The viewpoint thus obtained and the knowledge of ac- 
 tivities In other sciences are not to be gained so efficiently by 
 even a wide range of reading. There Is ever present the neces- 
 sity of discussing with authorities In physics, chemistry or psy- 
 chology some phase of the problem of disease In man. 
 
 "Further there Is the advantage to the medical student of be- 
 coming less a school-man and more a university-man with a 
 broader outlook on the problems of life — an advantage gained 
 by the subtle Influence which Is Involuntarily and unconsciously 
 acquired from association with his fellows In other faculties." 
 
 Dr. Graham Lusk, professor of physiology, formerly in the 
 Yale and the University Bellevue Medical Schools, now in Cor- 
 nell University Medical College, a man of international repute 
 in his science and of wide acquaintance with the problems of 
 medical education, especially the relations of medical schools 
 and hospitals, writes : 
 
 "I would say that, given favoring conditions for hospital de- 
 velopment, all the university buildings would best form a 
 group." 
 
 Dr. Henry H. Donaldson, for several years professor of 
 neurology In the University of Chicago, and now head of the 
 department of neurology In the Wistar Institute of Anatomy 
 and Biology, writes : 
 
 "With the growth of laboratories and apparatus and the de- 
 vices for communication, the fundamental importance of per- 
 sonal contact in the advance of knowledge has suffered some 
 
 30 
 
neglect. Specialization requires to be supplemented by coop- 
 eration. The passing comment or appreciation, the incidental 
 conversation, are most potent. They prevent useless labor and 
 reveal unsuspected relations. This form of intellectual stimu- 
 lus, always difficult to cultivate even under favorable conditions, 
 becomes well nigh impossible in the face of geographical sepa- 
 ration. The farther the sciences divide, the more imperative is 
 the concentration of all workshops at one spot. I hope Colum- 
 bia will be able to solve her problem in the interests of pos- 
 terity." 
 
 At the beginning of this communication we called attention 
 to the fact that in the discussion of the future of the school of 
 
 medicine and the university hospital, the In- 
 Views of terests of the rest of the university had been 
 
 Columbia Pro- almost wholly overlooked. In view of this 
 fessors we have been interested In learning the views 
 
 of our colleagues at Mornlngslde Heights, 
 whose field of work touches that of the medical school. With- 
 out exception, they have welcomed the idea of a possible closer 
 association of the school with their respective departments and 
 others allied to theirs. 
 
 Thus Professor Boas, of the department of anthropology, 
 writes : 
 
 "It seems to my mind that the location of the two branches 
 of the university near together seems to be entirely advanta- 
 geous, on account of the possibility of mutually profiting by par- 
 ticipation in our work. I appreciate the practical difficulties 
 which are In the way. It seems to me, however, that If It 
 were possible to place anatomy and physiology near the uni- 
 versity, very great benefits might accrue to both institutions. 
 We need very much the opportunity for work In these branches 
 In the university, which would be greatly facilitated if they were 
 located right here. This would be particularly beneficial to psy- 
 chology and anthropology. I go so far that I should like to see 
 a building devoted entirely to the needs of psychology, physi- 
 ology and anthropology. I believe that the advantages for the 
 medical school would also be very important, particularly inas- 
 much as the young students would remain more closely In touch 
 with the broader university spirit, and would not so early con- 
 
 31 
 
centrate their attention entirely upon the practical needs of their 
 final examination. Thus could be broadened the scientific inter- 
 ests of your graduates." 
 
 Professor Wilson, of the department of zoology, writes : 
 
 "As far as my own department of zoology is concerned — and 
 I think the same may be said of a number of other departments, 
 for instance, that of botany — these advantages [of geographi- 
 cal propinquity of the medical school, hospital, and the rest of 
 the university] would be in some respects very great. There 
 are in the medical school as at present organized at least four 
 departments which represent subjects, any one of which may 
 form a desirable minor subject for a doctor's or master's degree, 
 taken by students whose major subject lies in the university de- 
 partments in question. These departments are those of anat- 
 omy, bacteriology, physiology and physiological chemistry. As 
 you are aware, physiology has frequently been taken as a minor 
 by students of zoology and the same may be said also of the 
 other departments which I have mentioned. The advantages of 
 a close association between these departments and my own are so 
 obvious as to require no discussion. From every point of view 
 it would be very much to our advantage could the work of these 
 departments be carried on in, laboratories that are close to our 
 own. As matters now stand, much time is lost by the necessity 
 that our students find themselves under of going so far to carry 
 on their work in the medical school. 
 
 "Apart from the student point of view, 'the advantages of a 
 closer association between the instructors in our department and 
 in those of the medical school are evident. For these reasons 
 and others which might be mentioned, I should be heartily in 
 favor of any action looking toward the transfer of the medical 
 school to a site upon or near the university grounds." 
 
 Professor Morgan, of the department of zoology, writes: 
 
 "Without attempting to speak of the advantages to the uni- 
 versity in general that might accrue if the medical school were 
 situated in this vicinity, I may be permitted to express an opinion 
 as to the advantages to the zoological department that might be 
 hoped for. Many of our undergraduate students look forward 
 to a career in medicine. The importance to them of their 
 zoological work and the seriousness of the work might be 
 brought home if the body of medical students mingled more 
 
 32 
 
freely with the undergraduates. But it is in regard to the more 
 advanced students and to the members of our staff itself that I 
 wish especially to speak. The medical men are in daily touch 
 with actual problems of humanity. Our students and we our- 
 selves live in a rather academic atmosphere where the applica- 
 tions of our studies are somewhat remote. The crossing of 
 these two currents cannot be without beneficial results. It is, 
 however, the investigator in the medical field that is most es- 
 sential to us. There is only an artificial barrier that separates 
 the investigator in physiology, pathology, bacteriology and anat- 
 omy from the investigator in the zoological field. We need each 
 others' experience at every turn. As it is impossible to duplicate 
 in the university the work done by the advanced students in the 
 medical sciences we are correspondingly isolated from a group 
 of men whose work is closely akin to our own. This seems to 
 me to be the chief argument, from our point of view, for bring- 
 ing the medical school nearer to us." 
 
 Professor Cattell, of the department of philosophy and 
 psychology, writes : 
 
 "It seems to me that psychology suffers at universities such as 
 Columbia, Harvard and the Johns Hopkins from the fact that 
 the medical school is so far distant as to be almost a separate in- 
 stitution. Union Theological Seminary, which is a separate cor- 
 poration, seems to be more nearly an educational part of Colum- 
 bia University than the College of Physicians and Surgeons, and 
 we have more to do with its professors and students. Both the 
 fundamental sciences given at the medical school, such as physi- 
 ology and anatomy, and the clinical subjects such as neurology 
 and psychiatry, are of great importance for students of psychol- 
 ogy ; they would be more likely to follow them and to gain more 
 from them if the medical school were adjacent to us and were an 
 integral part of our work, than under existing conditions. At 
 present we regard it as desirable to give In the department 
 courses In abnormal psychology, which ought not to be neces- 
 sary, if the courses In the medical school were available, and to 
 arrange for our students to attend clinics in different parts of 
 the city, when it would doubtless be better If there were a well 
 organized hospital and clinics adjacent to us and under the con- 
 trol of the university." 
 
 Professor Woodworth, of the department of philosophy and 
 psychology, writes : 
 
 33 
 
"The department of psychology would expect distinct advan- 
 tages from the neighborhood of the medical school. We fre- 
 quently have students who wish to study the brain or nervous 
 and mental diseases, as well as general physiology. At present 
 it is difficult to make a combination in the student's program 
 between our work and that at the medical school and thus the 
 neighborhood of the medical school would be a distinct advan- 
 tage. Furthermore, I believe the opportunity for frequent in- 
 tercourse between our teaching staff and the staff of the related 
 departments in the medical school would be of considerable ad- 
 vantage to us. 
 
 "On the other side, I believe that occasionally we should be 
 able to contribute something to the education of the medical 
 student. Those who are preparing for special work in nervous 
 and mental diseases often come to us to take some psychology, 
 but they find the long journey a hindrance and I have no doubt 
 that many who would profit by our courses are unable to avail 
 themselves of them at present." 
 
 It may be pertinent here to call to your attention your own 
 
 words uttered on January 17, 19 10, in an- 
 
 View of Presi- nouncing to the faculty of medicine the proj- 
 
 dent Butler ect of the trustees for the reconstruction of 
 
 the medical school at Mornlngside Heights. 
 
 "I cannot refrain from pointing out what I believe to be the 
 immense educational advantage of bringing about a physical 
 unity between the medical school and the rest of the univer- 
 sity. The consequent close association with other university 
 teachers and students on the part both of members of the teach- 
 ing staff and members of the student body at the medical school 
 cannot fail to be in every way advantageous. A closer alliance 
 will be formed between the work of men engaged In research 
 under the faculty of pure science and those engaged In research 
 under the faculty of medicine. The medical students will be 
 able to enjoy, what they have not heretofore had, namely, the 
 pleasure and profit of academic residence and of close academic 
 association." 
 
 Dean Woodbridge has recently written : 
 
 "I am of the opinion that there Is decided gain both educa- 
 tionally and economically In having the various departments of 
 
 34 
 
the university in the same geographical location. The inter- 
 relations between the various departments are growing to be 
 yearly more intimate and there is a strengthening of university 
 spirit by the presence in one locality of the important branches 
 of the institution. Indeed, if the question is raised as a purely 
 theoretical question I do not see how it is debatable." 
 
 In one special field of the work of the university physical as- 
 sociation is especially desirable, namely, in the school of sanitary 
 science and public health which Columbia 
 Medical School must ere long establish. After approving ac- 
 and School of tion by the medical faculty in 1903 and 1908 
 Sanitary the matter of inaugurating such a school was 
 
 Science thoroughly considered by a committee ap- 
 
 pointed in December, 1908. This committee 
 consisted of Professors Lambert, Lee and Starr and Dr. Dit- 
 man of the College of Physicians and Surgeons and Professors 
 Burr, Calkins, Devine, Farrand, Goetze, Seligman, Tombo, and 
 T. D. Wood, representing a wide range of interests in the uni- 
 versity outside the micdical school. On April 26, 1909, this 
 committee submitted its report and advised the establishment 
 of a school of sanitary science and public health, distinct from 
 existing schools but making use of the equipments of several of 
 them. If such a school were established instruction in it would 
 be shared by at least the departments of physiology, biological 
 chemistry, pathology, and bacteriology now at 59th Street and 
 the departments of civil engineering, anthropology, chemistry, 
 political science, administrative law, social science and psy- 
 chology now at Morningside Heights. It would be exceedingly 
 difficult to adjust the work of the students In their several 
 courses without Involving much loss of time due to the necessity 
 of traveling back and forth between the two sites. Moreover, 
 the school would suffer seriously from the lack of unification 
 and solidarity that is essential to the success of any such institu- 
 tion. Apropos of this Professor Burr, of the department of 
 civil engineering, writes : 
 
 "If there should eventually be a department or school of 
 sanitary science established here, that department would unques- 
 
 35 
 
tionably greatly benefit by having the College of Physicians and 
 Surgeons in near vicinity to it. I hope such a department or 
 school may eventually be established." 
 
 Mr. Daniel D. Jackson, lecturer in sanitary engineering, 
 
 writes: 
 
 "There is great need of better schools for the training of pub- 
 lic health officers and Inspectors, and the public is now beginning 
 to demand that such men shall be specifically trained for the 
 Important duties which they have to perform. Harvard and the 
 University of Pennsylvania have already started such courses, 
 but Columbia has so far only her course in sanitary engineer- 
 ing. 
 
 "With the College of Physicians and Surgeons In close prox- 
 imity, it would be possible to establish courses in public health 
 leading to the degree of C.S. (certified sanitarian) and D.P.H. 
 (doctor of public health). This union would also admit of 
 graduate courses In advanced protozoology, bacteriology, physi- 
 ology and physiological chemistry, which would be mutually 
 beneficial and serve to add strength to the courses in biology, 
 chemistry and sanitary engineering, as well as to the variety and 
 scope of subjects taught in the College of Physicians and Sur- 
 geons. Sanitary science and the sanitary arts which are now be- 
 ing taught in the Schools of Mines, Engineering and Chemistry 
 will be greatly strengthened by the proposed union, and the Col- 
 lege of Physicians and Surgeons will be assisted in its hygiene 
 and preventive medicine. It may be beneficial to train the medi- 
 cal student more thoroughly in the causes and prevention of 
 diseases, and give him an optional opportunity to take courses 
 in advanced chemistry and biology. 
 
 "I thoroughly believe that the separation of the two schools 
 at a distance which cannot be traversed between courses Is a 
 detriment in the economy and efficiency of both Institutions." 
 
 Our thesis then is, that from the standpoint of the ideal 
 school of medicine, the future College of Physicians and Sur- 
 geons, together with the future university 
 View of Medi- hospital, ought to be situated in the imme- 
 cal Faculty diate vicinity of the other schools of the uni- 
 
 versity. It will be recalled that on January 
 17, 19 16, the faculty of medicine put itself on record in favor 
 of such a disposition of the school as follows : 
 
 36 
 
"Resolved, That In the judgment of the faculty, the trans- 
 feral will be for the best interests of the future development of 
 the school of medicine at Columbia." 
 
 The situation created in connection with the proposed trans- 
 feral was referred at the time to a committee of the faculty of 
 medicine consisting of Dean Lambert and Professors Hunting- 
 ton, Blake, Janeway, Wood and MacCallum. This committee 
 reported at length to the faculty on October 17, 19 10. Not 
 the least interesting portion of their report consists of the com- 
 mittee's replies to eight objections that had been proposed to 
 the proposition of removal to Morningside Heights. Among 
 its final conclusions and recommendations, the committee sub- 
 mitted the following : 
 
 "That the College should move from 59th Street and that 
 the proposed site at i T6th Street, provided the additional space 
 for an university hospital be secured, offers the greatest num- 
 ber of possible advantages compared with any plans of develop- 
 ment which have been proposed." 
 
 The report of the committee was made a special order for dis- 
 cussion at a subsequent meeting of the faculty. The discus- 
 sion was, however, finally postponed indefinitely because the 
 immediate failure to obtain the necessary funds to effect a re- 
 moval and the subsequent alliance with the Presbyterian Hos- 
 pital turned the thoughts of the faculty to a different disposi- 
 tion of the school. This we believe to be wholly unwise. 
 
 In our endeavor to be impartial we have searched widely for 
 objections to our main thesis. We confess that we can find no 
 opposing argument that Is of serious moment. It may be said 
 that we have presented merely an Ideal proposition, a Utopian 
 scheme, acquiescence in which Is easy, but that the university Is 
 obliged to face a very practical financial situation and that this 
 must decide the future of the school of medicine. But ought 
 this to be so? Ought the present lack of money to Influence a 
 university of such high Ideals as is Columbia, and one which In 
 the achievement of its Ideals has already solved so many finan- 
 cial problems as has Columbia, now to abandon an ideal and 
 
 37 
 
accept something that is obviously Inferior? The College of 
 Physicians and Surgeons has never assumed in the world of 
 learning the high position which is its just due by reason of its 
 seat in the metropolis of America and its connection with Amer- 
 ica's greatest university. For a period of just one hundred 
 years it has been receiving Columbia's aid in various ways. In 
 1 8 13 it was enriched by the discontinuance of Columbia's school 
 of medicine and the transfer of the latter's faculty to the newer 
 rival. In i860 it formed an alliance with the university. This 
 alliance grew into a definite merger in 1891. Thus for a cen- 
 tury the medical school has been approaching a university ideal. 
 But geographical isolation will always hamper It In the fulfill- 
 ment of Its aspirations. We believe that geographical propin- 
 quity, on the other hand, with all that that implies will immeas- 
 urably augment the prestige of the school in the learned world 
 and will prove to be the final essential factor in enabling it to 
 become one of the world leaders of scientific medicine. The 
 present Is the critical time. Ought Columbia to be satisfied with 
 anything less than the best ? 
 
 Respectfully, 
 
 Frederic S. Lee, 
 Frank H. Pike. 
 
 38 
 
COLUMBIA UNIVERSITY 
 
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