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SCIENCE 



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



that the men to be chosen must be great au- 

 thorities in the eyes of the public and the 

 profession is, to say the least, disconcerting. 

 To be a great authority in the eyes of the 

 public is surely no evidence even of being an 

 efficient consultant. Any one who is fre- 

 quently mentioned in newspapers as having 

 been called in consultation to treat this or that 

 rich or noted man, or who has charged enor- 

 mous fees, etc., stands as a great authority in 

 the public eye and, I am afraid, not infre- 

 quently also in the eyes of the profession — in 

 its present state of medical education. 

 - I come now to a more detailed statement of 

 my own suggestions. I shall say at the start 

 that whatever the ideal plan may be, it 

 should not be attained by revolutionary steps; 

 accelerated evolution gives tetter and safer 

 results than revolution. The changes should 

 not be introduced abruptly; they should be 

 gradually developed and adapted to the partie- 

 tilar condition of each individual medical col- 

 lege. But these changes should in all cases be 

 in the direction of one and the same ideal 

 jplan which could finally serve as a standard 

 for all medical schools. Now as to this plan. 

 I have given above a brief outline of it. But 

 it dealt only with the head of a medical de- 

 partment. I wish now to consider the com- 

 position of the entire department. Generally 

 it ought to be made up of the following four 

 groups : (1) A head for whom this position 

 should be his main occupation; (2) two, three 

 or more paid scientific assistants for whom 

 this position should also be their chief occu- 

 pation; (3) several professors and associate 

 professors, etc., for whom these positions will 

 be secondary occupations, their chief occupa- 

 tion being their private consultation or fam- 

 ily practise; some of these may receive mod- 

 erate salaries; (4) an unlimited number of 

 unpaid volunteer assistants. I should say 

 here that all these positions should be ap- 

 pointments, limited variously to varying 

 periods of years. 



The head should give about eight hours a 

 day to this, his main calling, and they should 

 be his fresh hours, say, from 8 a.m. to 4 p.m. 

 After these hours he may do with his time as 



he pleases. He may accept private consulta- 

 tions at his office or at the bedside and keep 

 the fees. But he should have no private pa- 

 tients at the hospital in the department of 

 which he is the head. If this hospital has 

 paying patients, all the income from these pa- 

 tients goes to the budget of the hospital. He 

 should not accept consultations for the first 

 eight hours of the day, and he should make it 

 his business to avoid spectacular consulta- 

 tions. He should do his best to be appreciated 

 by the best of his profession, but to do also his 

 best to avoid standing continuously in the 

 public eye. He should help to mahe medicine 

 a science and its teaching a serious husiness, 

 and hy his behavior he should assist in the 

 efforts to deprive the practise of medicine of 

 its commercial aspect. For a head of a depart- 

 ment the first two reappointments should be 

 for five years only; a further reappointment, 

 if it takes place, should be until age limit. 

 This will serve as an efficient corrective 

 against misuse of position or mistaken elec- 

 tion. The salary of a head of a clinical de- 

 partment should at least equal the highest 

 given at that university. 



The election to headship must be based 

 upon evidence that for the past years the ap- 

 pointee has been continuously a close stu- 

 dent of modern medicine and showed efficiency 

 in teaching, as well as in research, in the sci- 

 entific and practical fields of medicine. The 

 work of the department should be conducted 

 with the aid of all three classes or groups, but 

 especially with the aid of the scientific assist- 

 ants. 



These shall be elected from graduates who 

 have given evidence of possessing higher abil- 

 ities and ambitions, and who had one year 

 service in a good hospital and one year labo- 

 ratory work in the science of medicine. They 

 shall be appointed for three years with sal- 

 aries varying from $1,000 to $2,500. During 

 the first period their entire time should be- 

 long to the department; when reappointed, 

 however, for a second period, they should be 

 required to give only about eight hours a day 

 to the department and use the balance of their 

 time for the acquisition of some kind of a pri- 



