696 



SCIENCE 



[N. S. Vol. XLIII. No. 1116 



able budget, which alas ! under present cir- 

 cumstances, rarely meets the demands of 

 the situation, the coordination of a large 

 staff of trained workers in clinical, chem- 

 ical, physical, bacteriological, serological 

 and physiological departments, and the or- 

 ganization of a system of group teaching to 

 which he must himself devote a very con- 

 siderable amount of his time. It is evident 

 that the director of such a department 

 should be a man who has had a rather 

 broad training, who shall have had a basis 

 of chemical instruction such as was im- 

 possible thirty years ago, and shall have 

 spent a sufficient amount of time in work in 

 each of the branches represented by the 

 subdepartments of his clinic to enable him 

 at least to comprehend the significance of 

 the work which is there being done, and 

 to carry out real supervision. 



Time was when the teaching of medicine 

 was, in great extent, a matter of authority. 

 The student was led to accept precepts 

 enounced ex cathedra. To-day the teaching 

 of medicine is largely a matter of demon- 

 stration, of example, of practise. The stu- 

 dent is inclined rather to distrust precept 

 for which proof is not adduced ; he is offered 

 opportunities to study the symptoms of dis- 

 ease and its treatment by the bedside, and 

 is instructed in methods by which he may 

 control and confirm so far as may be, the 

 assertions which he may read in the book or 

 hear from the lips of the instructor. The 

 method of authority has given way to the 

 method of observation and inquiry. 



Who should preside over such a clinic as 

 this 1. Who is the ideal director of the mod- 

 ern medical department ? Thirty years ago 

 the professor of medicine was properly he 

 who had obtained the greatest reputation as 

 practitioner or consultant. This reputa- 

 tion was often not attained before the age 

 of fifty, and was gained through the active 

 practise of the art. Such a man, who with 



years, might or might not have attained 

 financial ease, might suitably, in these days, 

 have been called upon, at a nominal salary, 

 to direct a department and to give the two 

 or three hours a week which were the sum 

 total of the time exacted by the teaching 

 duties of the professor. 



But to-day it would be extremely diffi- 

 cult, nay, it would be almost impossible, for 

 a man with a considerable consulting prac- 

 tise to organize and direct a medical clinic, 

 such as that which I have outlined, and, in 

 addition, to do the amount of personal teach- 

 ing which would be necessary. The prac- 

 titioner, even if he be purely a consultant, 

 is not master of his own time. He may 

 limit his consultations to special hours, but 

 he can not cut off the increasing calls which 

 appeal to his sympathy and come at any 

 moment. And even if he see ever so few 

 patients, he can not control the complicating 

 side-questions to which relations with any 

 one ill human being are too apt to give rise. 



With the consultant as with the practi- 

 tioner sensu stricto the human influence is 

 the most important element in his work. 

 The preliminary conferences indispensable 

 for the establishment of the necessary rela- 

 tions of sympathy between physician and 

 patient, the interminable confidences of the 

 nervous invalid, the unravelling of the 

 tangled mental, complexes of the psycho- 

 neurotic sufferer, the heart to heart talks, 

 the breaking of sad news, the straightening 

 out of tlie many complications which so com- 

 monly arise in connection with grave ill- 

 ness, the letters to physician and family, 

 the interviews with friends and relatives 

 — these, as the consultant well knows, are 

 the duties that consume his time ; but they 

 are necessary and essential parts of his 

 work. It is not the actual time that the 

 physician spends in the study of his patient 

 — that is often the smaller part of it. It is 

 the accessory duties that render it impossi- 



