May 19, 1916] 



SCIENCE 



697 



ble for such a man properly to combine 

 active consulting practise with the responsi- 

 bilities of the directorship of a large mod- 

 ern clinic. 



To accept such a position would necessi- 

 tate the abandonment of a large part of that 

 physician's practise; this would mean the 

 loss of the main source of his income, un- 

 less he were a man of independent means. 

 If then the professor of medicine in a mod- 

 ern university is to be chosen from the ranks 

 of those men who have acquired great ex- 

 perience through professional success, it 

 will be necessary either that the university 

 shall pay a very considerable salary, or 

 that the professor shall be a man of inde- 

 pendent means. Such a salary, unfortu- 

 nately, if men of this class are to be ob- 

 tained, would have to be quite beyond any- 

 thing that is at present possible in most 

 universities. The successful consultant is 

 usually put to considerable expense for the 

 maintenance of the machinery necessary for 

 his work, and in many instances comes to 

 maintain a sort of existence which involves 

 large financial responsibilities. However 

 much such a man might desire to avail him- 

 self of the fascinating opportunities offered 

 by the directorship of a large medical clinic, 

 it is too commonly the case-that, by the time 

 he has well entered upon his fifth decade he 

 has already assumed responsibilities toward 

 others which make it impossible for him 

 rightly to abandon the sources of his in- 

 come. But this, it seems to me, is not the 

 essential feature of the situation. Is the 

 physician who through years of practise has 

 become the successful consultant, the man 

 who is best fitted to direct a large depart- 

 ment of medicine or surgery ? By no means 

 always. Indeed, in ibhe majority of in- 

 .stances, it is another course of life which 

 should best fit a man for a university pro- 

 fessorghip. 



There has arisen graidually in this coun- 



try a new class of consulting physician, the 

 man who has deliberately planned his career 

 from the outset, who has sought through 

 long years of study in hospital and in labo- 

 ratory, in association with large clinics, to 

 gain in a concentrated fashion, as it were, 

 that experience which may make his clinical 

 opinion, both from a diagnostic and thera- 

 peutic standpoint, most valuable. Long- 

 continued service in institutions in which 

 proper opportunities for study and research 

 are ofi'ered, is giving to the public to-day a 

 number of men who, while thoroughly 

 trained and practised in modern methods of 

 diagnosis and treatment, have accumulated, 

 at a relatively early age, a store of actual 

 clinical experience such as is acquired in 

 independent practise only after a much 

 greater time and, in the majority of cases, 

 with a loss of touch with some of the more 

 recent advances in medical science. These 

 men, the products of intelligent methods of 

 hospital management and organization, are 

 as a rule soon called on by their colleagues 

 in more active practise for advice and as- 

 sistance as general consultants. Men who 

 have pursued such a career, which has in- 

 evitably involved at the outset a consider- 

 able financial sacrifice, are usually men of 

 scholarly tastes who keep in touch with 

 laboratories in which they may continue re- 

 search and cooperate with their colleagues 

 in practise in the study of the nature and 

 treatment of diseases. It is from this class 

 of men that the professorships of medicine 

 are more and more likely to be filled. Such 

 a man may well enter upon a professorship 

 by the time, or even before, he is forty years 

 of age. 



This leads us directly to one of the ques- 

 tions which has been most actively discussed 

 of recent years : Is a man who has obtained 

 his clinical experience largely or purely in 

 hospitals properly fittted to teach students 

 the essentials of the practise of medicine ? 



