594 



SCIENCE 



[N. S. Vol. XLIV. No. 1139 



years, the present trend is toward full- 

 time clinicians, as it has been toward full- 

 time laboratory men for the medical sci- 

 ences, thus placing the whole university 

 mechanism on a university footing. Johns 

 Hopkins University has been the leader in 

 this as in many other phases of medical 

 teaching. Medicine, surgery and pediatrics 

 have been placed on a full-time basis and 

 the professors are not allowed to engage in 

 private practise. Pay patients may be 

 treated by them in Johns Hopkins Hos- 

 pital, the fees going to the support of the 

 hospital, the professors being entirely de- 

 pendent upon their salaries or private in- 

 comes. This is the most drastic step taken 

 by any university in the world, not exclud- 

 ing Germany. Meanwhile the world looks 

 on and if it is wise, reserves judgment. 



Dr. S. J. Meltzer, of the Rockefeller In- 

 stitute, in Science for October 30, 1914, 

 has a most interesting and important ar- 

 ticle on "Headship and Organization of 

 Medical Departments of First Class Med- 

 ici Schools." He proposes to attain the 

 ideal not by revolutionary steps because he 

 says "Accelerated evolution gives better 

 and safer results than revolution." For 

 the clinical chair he proposes: 



1. A head for this position, for whom 

 the position should be his main occupation ; 



2. Two, three or more paid scientific 

 assistants, for whom this position should 

 also be their chief occupation; 



3. Several professors and associate pro- 

 fessors, etc., for whom these positions will 

 be secondary occupations, their chief occu- 

 pation being their private consultation or 

 family practise. Some of these may re- 

 ceive moderate salaries; 



4. An unlimited amount of unpaid vol- 

 unteer assistants. 



He thinks that all these positions should 

 be appointments limited to varying periods 

 of years. 



He thinks the head should give about 

 eight hours a day to his main calling and 

 that they should be his fresh hours, say 

 from 8 a.m. to 4 p.m. After these hours 

 he may do with his time as he pleases. 

 "But he should have no private patients 

 in the hospital in the department of which 

 he is the head." 



Proper clinical teaching is only possible 

 if teaching institutions own or completely 

 control hospitals which are ready to dis- 

 charge their double function. This double 

 function involves the care of the patients 

 of to-day and, not less important, the better 

 care of the patients of to-morrow through 

 teaching and research. Hospitals should 

 not be simply boarding houses for the sick 

 but institutions for research, study and 

 teaching. Fortunately both these ends, 

 viz., care of patient and teaching, are best 

 served by the same plan. 



The best results are obtained where the 

 university owns its own hospital which is 

 conducted primarily as a teaching and re- 

 search institution. This safeguards at the 

 same time the best interests of the patient. 

 By arrangement with municipal and other 

 public bodies, university medical schools 

 may assume sole responsibility for the pro- 

 fessional conduct of municipal or semi- 

 private hospitals, guaranteeing the best pos- 

 sible service, but such hospitals can not 

 easily be made integral parts of the teach- 

 ing plant of a university. They should be 

 accessory. Provinces and states will find 

 the truest financial economy in coordinating 

 their state universities with state hospitals 

 and other state institutions of all kinds. 

 Around the state university may be grouped 

 the state hospital for the care of medical, 

 surgical, obstetrical and special cases; one 

 or more of the state institutions for the 

 cure of tuberculosis and the care of the 

 incurable, and a state receiving depart- 

 ment for the observation and classification 



