JiLY 30, 1909] 



SCIENCE 



39 



are so deeply interested in the work of in- 

 vestigation that they voluntarily limit their 

 outside practise and devote a considerable 

 portion of their time and energy to genuine 

 research. These are noble spirits, for they 

 make a real sacrifice for the sake of a 

 worthy principle. Medicine owes much to 

 them not only for results actually obtained, 

 but also for their example and influence 

 wliich permeate the whole department Avith 

 which they are connected, and influence 

 favorably to some extent every student 

 brought into contact with them. But the 

 number of such men is very small, for I 

 would not add to this honor list those 

 whose names appear sometimes in our liter- 

 ature as contributors, but who are in real- 

 ity patrons of research rather than actual 

 workers. The position of our clinical pro- 

 fessors in relation to their duties toward 

 the school, on the one hand, and their oppor- 

 tunities for increasing their private prac- 

 tise, on the other, is so similar to that which 

 formerly existed in the departments of the 

 medical sciences that one naturally as- 

 sumes a similar outcome. The practitioner 

 was displaced from the chairs of anatomy, 

 physiologj' and pathologj^, because the sci- 

 entific knowledge and laboratory technique 

 had become so specialized that it was im- 

 possible for the man in practise to do the 

 professorial work with honor and success. 

 The principle of competition between the 

 schools soon determined which kind of pro- 

 fessor was most needed. In the same way 

 precisely science and laboratory technique 

 and the spirit of investigation are pushing 

 hard into the clinical branches. The pro- 

 fessor of medicine who gives himself to 

 outside practise, and at the same time at- 

 tempts to keep up with the scientific de- 

 velopment of his subject and to make and 

 direct the investigations which his position 

 in a good school demands is putting himself 

 under a great strain at present, and the 



indications are that soon this strain will 

 become too great. Specialists will be de- 

 manded for the heads of our practical 

 branches as they are now for our theoret- 

 ical branches. It seems quite possible that 

 here again the principle of competition will 

 be the decisive factor. The university 

 school which shall first establish depart- 

 ments on this basis may, and in my opinion 

 will, secure both reputation and students 

 as compared with schools organized on the 

 present system. Whether a professor of 

 medicine, surgery, obstetrics, etc., whose 

 practise upon patients is limited to the hos- 

 pital and dispensary will be as well quali- 

 fied as the man with an extensive outside 

 practise to teach his students medical art as 

 well as medical science, and to attain the 

 proper influence among his brother physi- 

 cians are questions that have been somewhat 

 discussed, but the only way to find out the 

 correct answers is to try the experiment. 

 All the theoretical reasons favor such a 

 change. The practise of the hospital is 

 much more rigorous than private practise 

 from the standpoint of the aeqiiisition of 

 the methods of diagnosis and treatment. 

 I fancy that any physician will admit that 

 experience and real knowledge accumulate 

 at a rapid rate in the hospital as compared 

 with the results of the looser discipline of 

 outside practise. A man whose diagnoses 

 are based upon the most complete examina- 

 tions possible and whose errors are continu- 

 ally subject to the salutary correctives of 

 autopsy and pathological demonstration is 

 likely to make a very exact and practical 

 teacher. As regards the matter of the re- 

 lation of these men to the medical public 

 there can be no room for a difference of 

 opinion. It is they who would have the 

 golden opportunity to acqiiire precise 

 Imowledge, to keep thoroughly abreast of 

 the latest and best in the medical world. 

 It is they who in medical societies and 



