544 



SCIENCE 



[N. S. Vol. XXX. No. 773 



the future. A medical school must control 

 appointments in the hospitals where its 

 clinical teaching is done and the terms of 

 service must be continuous throughout the 

 year if the highest development is to be 

 attained. Clinical professors, like other 

 university professors, must be chosen be- 

 cause they are the best teachers and inves- 

 tigators available and this can never be the 

 case so long as only local men are possible 

 of selection. 



Medical schools themselves have been re- 

 sponsible in part for the present state of 

 clinical teaching on account of the very 

 meager salaries, or vs^orse still, no salaries, 

 paid its clinical teachers. This has re- 

 sulted frequently in teaching receiving 

 just as much attention as under these con- 

 ditions it deserved, i. e., secondary consid- 

 eration. Medical schools have expected 

 the clinical teacher to be remunerated by 

 the advertising the position gave him and 

 when the advertising was profitable they 

 have complained because private practise 

 has interfered with school work. "SVhat 

 else, pray, could be expected? Let us sup- 

 pose that a university had attempted to 

 develop its chemical department, for ex- 

 ample, by limiting its choice of instructors 

 to its locality, paid them slight or no sal- 

 aries, asked them to make a livelihood 

 doing private chemical work, such as as- 

 says, etc., and had them work in buildings 

 and with apparatus owned and controlled 

 by another corporation. How absurd the 

 proposition! How could a university 

 chemical department develop under these 

 conditions? Yet these are conditions not 

 essentially ditferent from those under 

 which many, many medical schools have 

 attempted to develop clinical departments. 



I would impress on the governing boards 

 that a medical department is very expen- 

 sive. Numerous laboratories are needed, 

 and much apparatus. Professors and in- 

 structors in the laboratories must be paid 



university salaries and often the maximal 

 salaries, since there is a growing demand 

 for the better instructors, and an institu- 

 tion can not afford to lose too many of its 

 trained men. Clinical professors must be 

 paid salaries, too, in proportion to the time 

 they give to teaching work. Of clinical 

 teachers there should be two classes, those 

 who devote a large part of their time to 

 medical school work and those who devote 

 a small part. In the first group should 

 come at least the heads of the more impor- 

 tant departments, such as medicine and 

 surgery. Some advocate having professors 

 of medicine and surgery who engage in no 

 private practise but confine their work to 

 the medical school and the hospital. It is 

 an advantage, however, to my mind, for 

 them to do a limited amount of private 

 work because much of the best material for 

 study comes through these channels and, on 

 the other hand, the public has a right to 

 some of the services of these more highly 

 trained men. These men will probably 

 have to be paid more than university sal- 

 aries for both hospital and medical school 

 work, since they would be men who in pri- 

 vate work would earn far larger incomes. 

 In addition to these men devoting the 

 major part of their time to academic work, 

 the services of the men in private practise 

 are needed. They are in a position to 

 teach to students particularly well the art 

 of medicine, if I may use the word without 

 being misunderstood. From their partic- 

 ular experience they have something of 

 value to impart to students and they should 

 be made use of and paid in ratio to the 

 time devoted to teaching. Then the med- 

 ical school of to-day requires a very large 

 teaching force, since so much of the teach- 

 ing can be done satisfactorily only in small 

 groups of students. This again increases 

 the cost of medical instruction. 



In medical schools the older fixed cur- 

 riculum is giving place to a modified elect- 



