Makch 12, 1915] 



SCIENCE 



389 



much as the professor of chemistry or of 

 physics. His university work commands his 

 time. He must allow nothing to interfere with 

 his teaching, his clinical work in the hospital 

 or his research, and he devotes on the average 

 quite as much time to his university work as 

 does his colleague in chemistry or in mathe- 

 matics. In addition to this, however, he 

 devotes some time each day to private prac- 

 tise by which he maintains his position before 

 the profession and the public as a great spe- 

 cialist. This can be done without neglecting 

 his imiversity position. In fact, if he does not 

 remain the great physician, he ceases to be of 

 as much value either to his students or to his 

 university. On the other hand, if he should 

 neglect his university work because of the time 

 he devoted to private practise, his services 

 would be dispensed with. 



This problem of clinical teaching has been 

 taken up during the year by the General Edu- 

 cation Board and, as a result, an interesting 

 experiment is to be tried at Johns Hopkins 

 and possibly at one or two other places. The 

 General Education Board has given Johns 

 Hopkins $1,500,000 endowment with which to 

 pay salaries to the departments of medicine, 

 surgery and pediatries. The position is taken 

 in this experiment that the head of a clinical 

 department should be given a very large salary 

 and should receive no fees for private practise. 

 It was recognized at once that the rich should 

 not be deprived of the services of these experts, 

 so the grotesque plan is proposed that these 

 men may do private practise, but that fees 

 from that practise are to be turned into the 

 university treasury and not into their own 

 pockets. [As will be seen by the context the 

 word " grotesque " does not apply to the plan 

 as a whole but is used to characterize that part 

 of it which proposes that these clinical teach- 

 ers may do private practise but are not per- 

 mitted to receive any fees for these services, 

 the understanding being that the fees are to be 

 assessed and collected and appropriated by the 

 university or hospital. I desire to assume the 

 full responsibility for this particular portion 

 of the report and to submit that the terra 

 " grotesque " is an exceedingly mild one to 



characterize such an unethical and illegal 

 scheme. That the fees for the peculiarly indi- 

 vidual and personal service rendered by a 

 physician or surgeon to his patient should be 

 appropriated by any institution and not go 

 direct to the medical man rendering such serv- 

 ice is clearly unethical. It is equally clear that 

 it is illegal, as the institution would have no 

 standing whatever in court if it sought to col- 

 lect for itself the fees for such service. It is 

 interesting to note in this connection that al- 

 though these propositions are perfectly clear 

 to men who are practising medicine, they are 

 not as self-evident to non-clinical and non- 

 medical men who are not in a position to 

 understand the rights and interests of the 

 medical profession.] 



The men who proposed this plan, and pro- 

 vided the money necessary to make the experi- 

 ment, are non-medical men; they do not have 

 the medical point of view and they do not 

 understand the complex functions demanded 

 of the clinical teacher. 



This plan has not been well received by the 

 clinical teachers and finds its supporters al- 

 most entirely among the laboratory men. It 

 is difficult to understand if the teachers in a 

 medical school are to be placed on salaries and 

 not permitted to receive any compensation for 

 outside work, why the clinical teacher should 

 be given a very large salary and his colleague 

 in anatomy or in pathology a comparatively 

 small one. The sweating of the scientific men 

 who have devoted their lives to teaching and 

 research on miserable salaries is notorious. 

 Advantage has been taken of the fact that 

 their scientific enthusiasm would hold them 

 to their work and they are often as underpaid, 

 comparatively, as the workers in a sweat shop. 

 Surely, if the medical department of a uni- 

 versity receives large endowments for the pay- 

 ment of salaries, the men teaching in the labo- 

 ratory sciences should receive the first consid- 

 eration. Again, if a clinical department ob- 

 tained large sums for salaries, why should they 

 pay a very large salary to the head of the 

 department who in a very limited amount of 

 time devoted to practise could obtain for his 

 services much more than the amount of such 



