622 



SCIENCE 



[N. S. Vol. XL. No. 1035 



Hopkins University already began to experi- 

 ment with a cure for this unsatisfactory con- 

 dition. The Council of the Medical Educa- 

 tion finds this cure grotesque and defers its 

 own therapeutic plans until the committee of 

 ten clinicians has rendered its report on this 

 problem. Now, we never ought to ofPer any 

 treatment before we know exactly the nature 

 of the ailment. What ails the instruction 

 and instructors in clinical subjects in the med- 

 ical schools in this country? I do not find 

 that this phase of our problem, perhaps its 

 most essential part, has been anywhere an- 

 alyzed. I shall therefore attempt to do it 

 here. 



The report of the Council on Medical Edu- 

 cation lays great stress upon the requirements 

 that the clinical teachers must be " great au- 

 thorities in their special fields both in the eyes 

 of the profession and in the eyes of the pub- 

 lic." If that would be really the main cri- 

 terion of fitness, I would then say that pro- 

 fessors of medicine of to-day fulfill, at least 

 in most instances, their mission : they are 

 great authorities in the eyes of the public and 

 the profession; their offices are full and they 

 are consulted by physicians and the sick from 

 near and far. But are these authorities well- 

 fitted to be heads of clinical departments? 

 According to my way of thinking, I would 

 say that in most instances they are unfit for 

 these positions. Now let me give my reasons 

 for this statement, which may sound a little 

 too severe. 



I wish to introduce my argument by the 

 following two propositions, the correctness of 

 which ought to be apparent to every one. (1) 

 The proper preparation of practitioners of 

 medicine is a very serious task; it is of great 

 importance to the public as well as to the stu- 

 dent of medicine himself, and ought, therefore, 

 to be carried out as a primary occupation and 

 in an earnest and conscientious manner. (2) 

 No matteT whether we take a progressive or a 

 conservative stand in medicine, one and all 

 must agree that the student of medicine of 

 to-day must he taught the medical Jcnowledge 

 as it is hnown to-day. For this purpose let 

 us look at the activities of any head of a 



clinical department, let us say, of internal 

 medicine, who is, as the council demands, 

 " a recognized authority in his field in the 

 eyes of the profession and of the public " ; let 

 us see whether these activities comply with the 

 above-mentioned self-evident requirements. 

 Let us first scrutinize the history of one day 

 of one of our noted professors of medicine. 

 He has consultation hours every morning until 

 noon; the waiting room is crowded (he is the 

 " best diagnostician " in his town) and some- 

 times he has to remain in his office an hour or 

 two longer. As a rule he has to accept a few 

 bedside consultations with practitioners, which 

 again takes up many hours of his time in the 

 afternoon. He may even have to go out of 

 town for consultations. At any rate, including 

 the time given to his meals, etc., about ten 

 hours of his day are easily accounted for by 

 this activity. Then on account of his high 

 social standing in the community, etc., func- 

 tions have to be attended, for which his wife 

 makes the engagements; dinners have to be 

 attended and to be given; meetings of advisory 

 boards and of all sorts of committees have to 

 be attended. Then there are letters to be 

 written or dictated, bills and other business 

 matters to be looked after. No doubt that by 

 these diverse obligations at least about three 

 more hours of thei day are consumed. We 

 have thus far accounted for about thirteen 

 hours every day of the professor's time. Now 

 how much of his time is then left for teaching 

 medicine to students and attending to the 

 sick at the hospital? K I say three hours, T 

 am sure it is exaggerated in most cases. But 

 whether two or three hours, they are hours 

 left over from a very busy active occupation, 

 and the teaching is then done in most cases 

 by a worn-out man bodily and mentally. It 

 will be generally admitted that for nearly all 

 teachers of clinical subjects private practise, 

 with its commercial end, is the chief aim and 

 occupation, while the teaching part is at best 

 only a minor subject, and in not a few in- 

 stances only an ornament and unmistakably 

 a very desirable advertisement. I remember 

 how years ago a noted surgeon, who was the 

 professor of surgery at one of the best-known 



