Mat 19, 1916] 



SCIENCE 



699 



much more difficult and complicated. It is, 

 it seems to me, not easily possible for one 

 who wishes to fit himself for practise as a 

 consultant or for the teaching of medicine 

 to gain that experience which he should 

 have without a considerable association with 

 individuals of more complicated mental con- 

 stitution. Moreover, there are certain dis- 

 eases which, strangely enough, are rarely 

 seen in the free wards, yet are common in 

 outside practise, diseases the recognition 

 and management of which are of the utmost 

 importance. I need refer only to angina 

 pectoris. A man who is not familiar with 

 the mental attitude of the people among 

 whom he or his students are going to be 

 thrown, who has not learned by experience 

 successfully to navigate his bark through 

 the mist of accessory problems which befog 

 the antichambers of the sick room, is un- 

 able to give to the student much that will be 

 of real value in the practise of medicine. 

 But fortunately in many hospitals to-day, 

 the great development of private wards 

 offers abundant opportunity for the acquisi- 

 tion of just this experience. The man who 

 desires to fit himself for a position as teacher 

 of medicine or consultant should spend a 

 considerable period of time in practise 

 among the class of patients which is to be 

 found in the large private departments of 

 many of our hospitals. Such an experience 

 gained in the hospital wiE afford him in 

 concentrated manner just what he might ob- 

 tain otherwise through a much longer pe- 

 riod of time in private practise. 



This is the general course of training 

 which the aspirant to the professorship of 

 medicine is likely in the future to follow. 

 His elevation to the directorship of a large 

 department of medicine or surgery may be 

 directly from the clinic in which he has 

 occupied a salaried position and to which 

 he has given his entire energies, or it may 

 come after some years of consulting prac- 



tise during which he has preserved close 

 relations with an active clinical department. 



Recognizing the magnitude of the prob- 

 lems associated with the organization of a 

 large medical clinic, it has been felt that 

 such a department could best be presided 

 over by men who were able to give their 

 whole energies to the university in organi- 

 zation, in teaching, in the conduct and di- 

 rection of research. And, notably at that 

 institution with which I have been con- 

 nected for more than twenty-five years, sev- 

 eral of the clinical departments have been 

 reorganized upon a university plan. 

 Through the generosity of the General Edu- 

 cation Board, the institution has been en- 

 abled to establish a staff of university pro- 

 fessors and salaried assistants who take 

 charge of these clinics for hospital and uni- 

 versity. These men, freed from the calls of 

 outside practise, are able to give their entire 

 time to the service of the department in the 

 care of patients, the promotion and conduct 

 of research and in the teaching of medicine. 

 And as is well known, the members of this 

 staff have agreed to abstain from the prac- 

 tise of their profession for their own 

 emolument. 



The discussion associated with this ex- 

 periment has been very active, centering 

 largely upon the last mentioned circum- 

 stance — the withdrawal or abstention of the 

 university professors and their assistants 

 from private practise. Those who have ob- 

 jected to this procedure have regarded the 

 plan as unwise and even unfair to the physi- 

 cian himself, to the hospital, to the students 

 and to the public. 



In the first place, with regard to the pro- 

 fessor himself, it has been pointed out, and 

 with justice, that there can be little rela- 

 tion between the salary which the university 

 could or should pay to the professor of 

 surgery or medicine and the gross income 

 of the successful surgeon or consultant in 



