September 14, 1906.] 



SCIENCE. 



335 



select their teaching assistants in the hos- 

 pitals. 



In consequence of the short terms of 

 service in the hospitals (usually four 

 months) the clinical teachers do not have 

 patients under their own control through- 

 out the school year. As a result of this 

 condition two and often three men are 

 needed to give the same amount of instruc- 

 tion that is given by one man in the labora- 

 tory departments, i. e., teach the eight 

 months of the school year. As a result of 

 the large number of men necessarily ap- 

 pointed by the school under these condi- 

 tions the value of a teaching position is 

 much diminished, because the salary which 

 can be paid to each instructor is exceed- 

 ingly small and because the indirect pay 

 received in consequence of connection with 

 the school is by no means so great as it used 

 to be when the relative number of in- 

 structors was much less than at present. 



The months during which a man is on 

 duty in a hospital vary from year to year. 

 Only the older clinicians are reasonably 

 sure of certain months. A death or a 

 resignation may cause a shift of the time 

 of service for several men on the medical 

 or surgical side of a hospital. On this ac- 

 count it is difficult for the heads of the 

 clinical departments to plan in detail their 

 course of instruction for the school year 

 and for the summer. These difficulties hold 

 in an even more marked degree for their 

 subordinates. 



Unless the heads of the clinical depart- 

 ments in the school are also heads of the 

 clinical services in the hospitals they can 

 not choose their hospital assistants, and 

 even when they are heads of clinical ser- 

 vices they do not have an entirely free 

 choice ; that is, it is impossible for them to 

 select and use on their services the men best 

 qualified to teach. They must take as their 

 assistants those men who fall to their ser- 



vice by the method of assignment at pres- 

 ent employed. Under this condition of 

 affairs they may have as assistants men not 

 interested in teaching or with little or no 

 ability in that direction. Moreover, as 

 these younger assistants on a service change 

 from year to year, it is impossible to have 

 a thoroughly organized, trained and per- 

 manent teaching staff. 



Some of these difficulties could be elim- 

 inated by making the services continuous, 

 as is already the case at some of the hos- 

 pitals, but other difficulties are inherent in 

 the principle on which almost all hospitals 

 in this country are run, namely, the selec- 

 tion of local men only to serve on their 

 staffs. This leads me to speak of the most- 

 vital defect which now exists in the clinical 

 departments of the Harvard Medical. 

 School. It is the extremely limited field 

 of choice of clinical teachers. 



Since the school has practically no powef 

 of nomination or of appointment in the 

 hospitals of Boston, it must appoint as its 

 clinical teachers men who already hold hos-' 

 pital positions. The hospitals select their 

 men from the vicinity of the city of Boston 

 only. The result is that the hospitals of 

 Boston dictate all the clinical appointments 

 in the Harvard Medical School and thereby 

 limit the choice of all its clinical teachers 

 to Boston. 



Boston is altogether too small a field 

 from which always to obtain the best teach- 

 ers. No other departments in the univer- 

 sity or in the medical school are thus lim- 

 ited. All except the clinical departments 

 are able to select from any part of the 

 country the man M^ho is judged best fitted 

 for a teaching position which becomes 

 vacant. 



The number of desirable clinical teachers 

 is still further limited in two ways, by lack 

 of teaching ability on the part of many 

 who receive appointment to hospital staffs. 



