October 30, 1914] 



SCIENCE 



623 



medical schools, said to me : " They pay me a 

 thousand dollars a year. The fools! I would 

 pay them $5,000 for the professorship; it's 

 worth more than $25,000 a year to me." What 

 a deplorable condition! The teaching of the 

 pure medical branches which, for the physician 

 in the making, is the most important part of 

 his medical education, should be carried on by 

 worn-out men for whom it is invariably only 

 a secondary occupation and often not much 

 more than an ornament or an advertisement ! 

 Now let us come to the second proposition. 

 We have seen that the professor of medicine, 

 who is considered an authority by the profes- 

 sion and the public, is so busy that very little 

 time is left to him to carry on properly his 

 duties as a teacher. Is there any time left 

 him to study properly the advances which are 

 continually made in medicine? Let us study 

 the medical career of the best medical consul- 

 tant and professor. He graduated in medi- 

 .cine at the head of his class, he served as an 

 interne at a good hospital, he went abroad, 

 where he learned the then newest things in 

 medicine. After his return he soon became 

 assistant to a leading consultant and a pro- 

 fessor. For several years he made for his 

 •chief laboratory examinations with the older 

 and newer methods of diagnosis, saw some of 

 the chief's private patients, and was soon ap- 

 pointed adjunct at the hospital and instructor 

 in the department of medicine of which his 

 chief was the head. He saw some of the au- 

 topsies and compared them with the diag- 

 noses; found time to read some of the newer 

 medical literature, made himself several con- 

 tributions to it; assisted his chief in prepar- 

 ing and giving the lectures and helped him 

 in preparing a paper or two which had to be 

 flavored with some of the newer things in 

 medicine. Gradually he picked up a private 

 practise of his ovrai, which suddenly com- 

 menced to grow rapidly. He had to leave his 

 chief, consultations began to come in, and in 

 a short time he advanced to the position of at- 

 tending physician in several hospitals, and 

 perhaps also to the position of a clinical pro- 

 fessor in his school. His reputation and his 

 private practise grew, and with it grew his 



extensive personal experience; he was becom- 

 ing indeed an excellent physician. But in 

 exact proportion to this growth his spare time 

 grew less and less, and with it grew fainter 

 and fainter the first-hand acquisition of 

 knowledge of the advances of medicine, which 

 are going on in rapid strides all over the 

 world. There was no longer any idea of doing 

 some original work or of a patient study of 

 communications on entirely new subjects 

 which continually spring up in rapid succes- 

 sion. There was no real reading any more; 

 perusing of some articles, glancing at ab- 

 stracts, picking up one thing or another at 

 meetings and discussions, had to take the 

 place of study. Our authority is not an old 

 fogy who does not believe in the truth of 

 things which he does not know. On the con- 

 trary, he is a progressive man and knows how 

 to get at the new things. With a growing in- 

 come and with the cheapness of scientific 

 labor, he learned early to surround himself 

 with several young assistants, specializing in 

 various directions. The morphology and the 

 chemistry of the urine; the various morpho- 

 logical blood pictures, and the chemistry of 

 the blood; the bacteriology of diverse diseases 

 and the various immunity reactions; meta- 

 bolic studies, phlebograms and cardio-electro- 

 grams, etc., our authority gets a report on all 

 of them and is told of their possible signifi- 

 cance by his various young assistants. Of 

 course, his knowledge of these things as he 

 picks them up is extremely superficial; they 

 can be thoroughly grasped only by hard 

 study. But our authority has to use, and uses, 

 this superficial knowledge of new things in 

 consultations at the bedside, in the lecture 

 room and in papers and discussions at med- 

 ical meetings. 



To state it briefly: the store of more solid 

 knowledge of the best clinical teacher, as we 

 know him to-day, consists of that which he 

 had acquired during his undergraduate and 

 post-graduate studies and of the accumulated 

 personal knowledge gained by long empirical 

 observations at the bedside. Of the marvelous 

 advances which are continually made in all 



