September 14, 1906.] 



SCIENCE. 



337 



existing conditions, after their early hos- 

 pital training, young clinical men are com- 

 pelled to devote their energies to earning 

 a living and to acquiring a practise, and it 

 usually is several years before they receive 

 hospital appointments, as a result of which 

 they become available as teachers. 



In consequence of the lack of proper, 

 uninterrupted, early training under ca- 

 pable supervision, and as a result of the 

 temporary want of extensive opportunity 

 for bedside study and large experience at 

 the most important period of his life, it is 

 almost impossible for a clinical man to 

 reach any commanding position as a teach- 

 er in his line of work until he is past middle 

 life. This is not true in other lines of 

 work. 



There is no denying the fact that the 

 Harvard Medical School has done little for 

 its clinical men except to give them titles 

 which might prove of value in private 

 practise. It has paid them very small 

 salaries and given them absolutely no as- 

 sistance in their clinical teaching. The 

 school has received from many of its de- 

 voted clinical men, some of whom have 

 made great sacrifices for its sake and have 

 brought it great honor and reputation, 

 much more than it has given them. 



Under present conditions, with the school 

 giving its clinical instruction in hospitals 

 which are under the control of others, with 

 underpaid clinical teachers who have lim- 

 ited terms of hospital service, and who are 

 unable to select from the hospital staff and 

 from the internes, as their assistants, the 

 men they consider best fitted to teach and 

 to advance the knowledge of clinical medi- 

 cine, the school has about reached its limit 

 of development. 



From now on the Harvard Medical 

 School must have a new ideal to strive for, 

 namely, well-paid clinical instructors whose 

 chief interests shall be teaching and scien- 



tific medical investigation. In other words, 

 the clinical departments must be put on a 

 true university basis like the laboratory 

 departments and entirely freed from the 

 outside influences which hitherto have con- 

 trolled them. To render this ideal possible 

 two things are absolutely necessary: 



1. A sufficient endowment to enable the 

 school to pay clinical teachers adequate 

 salaries so that they can afford to devote 

 all their time to teaching and to research 

 work. 



2. A hospital of its own, or one in which 

 it has the power of appointment, in order 

 that it can do the following things: (a) 

 Furnish continuous services to its clinical 

 teachers. (&) Establish salaried teaching 

 positions in the wards for young clinical 

 men who will have charge (under the su- 

 pervision of visiting men) of the medical 

 students, who will carry on scientific in- 

 vestigation of clinical cases based on the 

 broadest training in laboratory methods, 

 and who will study to fit themselves to be 

 the clinical teachers of the future. (c) 

 Enable the clinical departments to call the 

 exceptional clinical man from any part of 

 the world and put him in control of ward 

 patients, (d) Place students, after they 

 have received sufficient preliminary train- 

 ing, in the wards as a part of the hospital 

 machinery so that they all may acquire 

 practical experience under proper super- 

 vision before they undertake to practise 

 medicine on their own responsibility. 



To demand such possibilities is perfectly 

 reasonable. Germany owes her great clin- 

 ical teachers to such a system of being able 

 to call to any vacant clinical position the 

 best available man in the country. Conse- 

 quently men fit themselves by years of 

 study in the hospitals to fill these clinical 

 positions. At least two medical schools in 

 this country have adopted the same system. 



