336 



SCIENCE. 



[N. S. Vol. XXIV. No. 611. 



and by promotion in hospitals on the basis 

 of seniority only. Hospitals for the most 

 part select the men on their staffs on the 

 basis of their ability as practitioners of 

 medicine, not on their ability as teachers 

 and investigators. As a result many hos- 

 pital men are not desirable as teachers or 

 are used with detriment to the instruction. 

 Moreover, hospitals usually select men 

 rather early in their careers, before they 

 have shown whether or not they possess 

 any marked ability as teachers or investi- 

 gators. The clinical men once appointed 

 are advanced almost invariably on the 

 basis of seniority, so that in time every 

 man becomes the head of a clinical service. 

 "This basis of promotion may put hospital 

 •services in the control of men uninterested 

 in teaching or inefficient in their work. 

 'There is no method of advancing rapidly 

 the strong man with ability as a clinician, 

 teacher and investigator, or of weeding out 

 the inefficient man. University devjelop- 

 ment, however, is based on the vital prin- 

 ciple of selecting the most capable young 

 men obtainable anywhere and developing 

 them rapidly to the limit of their capacity. 

 As a result of this present policy of pro- 

 motion in hospitals the school is sometimes 

 •obliged to select an inefficient man because 

 he is the head of a clinic and neglect a 

 capable young man who is subordinate to 

 liim. 



The result of this marked limitation of 

 the field of selection of clinical instructors 

 is that the clinical teachers of the school 

 are not always of the high grade desirable 

 and otherwise obtainable, and the broaden- 

 ing influence due to the introduction of 

 men with other standards and ideals from 

 mother parts of the country is prevented. 



I do not deny in the least that the clinical 

 1;eaehers of Harvard have always held a 

 Hgh rank and that many of them have 

 made valuable contributions to medical 



knowledge. I only wish to point out that 

 through circumstances over which the clin- 

 ical men themselves have no control the 

 school is unable to call to its service the 

 exceptional clinical man from outside of 

 Boston and put him in charge of patients. 

 The reason of this condition of affairs is 

 that the school has always been a parasite 

 on the clinical men and indirectly through 

 them on the hospitals for its clinical teach- 

 ing; i. e., while it has furnished its labora- 

 tory men with laboratory space and equip- 

 ment, it has not provided its clinical men 

 with wards and patients. It is only fair 

 to add, however, that this teaching has cost 

 the hospitals nothing and in many ways, has 

 been of advantage to them. 



The medical school of the present day is 

 no longer a place to train men solely for 

 the business of the practise of medicine, but 

 has become a technical school embracing 

 many branches of science. As teachers of 

 these different branches, trained men are 

 needed, just as in any other technical 

 school, e. g., of engineering. In the clinical 

 departments of most of the medical schools 

 in this country the clinical teachers neces- 

 sarily have had to make teaching a second- 

 ary part of their vocation. They have had 

 to seek private practise in order to make a 

 living. There have been open to clinical 

 men no teaching positions which paid sal- 

 aries large enough to enable men to live 

 suitably and comfortably on their salaries 

 alone ; hence there has been no incentive for 

 a man to fit himself for such a position. 

 The only way in which a man could be- 

 come a clinical teacher was by obtaining a 

 hospital position. 



At present there exists in most hospitals 

 in this country no method for the thorough 

 training of young men who wish to become 

 clinical teachers. A hospital interneship 

 is not a sufficiently long experience, but it 

 is all that is possible at present. Under 



