702 



SCIENCE 



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



probably give more or less of bis time to 

 private eonsultaitions at bis clinic. To tbe 

 consultant tbe puzzling and interesting 

 patbological problems brougbt for bis con- 

 sideration by patients sent to bis consulting 

 room by colleagues at bome and abroad, 

 form 'tbe most valuable part of bis experi- 

 ence. Sucb patients tbe professor of medi- 

 cine and bis associates will doubtless con- 

 tinue to see. Tbey sbould form a great ad- 

 dition to tbe bospital clinic. Some of tbese 

 patients tbey will desire to admit to tbe 

 bospital for study. But tbese consultations 

 tbe director of a large clinic could bold 

 only at stated periods, and to tbis work be 

 could give only a limited amount of time. 

 It is difficult to see bow it would be possible 

 for tbe director of sucb a clinic to give tbe 

 proper service to bis department, and yet 

 conduct anytbing like an active consulting 

 practise outside tbe institution. Under ex- 

 ceptional circumstances, bowever, tbe pro- 

 fessor will probably accept calls to outside 

 consultations, but only under exceptional 

 circumstances. Tbe director of a large 

 medical department must control bis own 

 time and bis engagements. He wbo is 

 openly occupied in general or in consulting 

 practise can never truly be master of bis 

 time. 



A curiously active discussion bas risen 

 upon a ratber .small point in connection 

 witb tbe practise of tbe salaried director 

 of a medical clinic. In some clinics, as bas 

 been said, tbe understanding exists tbat tbe 

 professor shall contribute whatever fees be 

 may collect from private patients to tbe 

 departmental funds. Tbis procedure bas 

 excited vigorous criticism and opposition; 

 it lias, indeed, been considered fundamen- 

 tally improper, subversive of tbe bigber 

 interests and principles of tbe medical pro- 

 fession. 



Tbis is a problem on wbicb I bave medi- 

 tated seriously, and, look at it as I may, I 



can not but regard it as a ratber small and 

 _ relatively unimportant detail of a larger 

 general question. Tbe professor sbould 

 naturally demand suitable compensation for 

 bis services to private patients. But 

 whether such compensation sbould go di- 

 rectly to him, or sbould be turned over by 

 him to tbe budget of bis department, seems 

 to me a matter of detail to be settled be- 

 tween him and university or hospital. I 

 am at a loss to understand the attitude of 

 those who see in tbis a question of principle. 

 Some time before the first experiment of 

 a university medical clinic was put into 

 practise, a distinguished clinician whose 

 services were sought by a well-known insti- 

 tution, offered independently, for the or- 

 ganization of his department a plan, which 

 is very similar to that wbicb now exists at 

 the Johns Hopkins University. This offer 

 outlined the establishment of bis professor- 

 ship upon a purely university basis, witb 

 the explicit understanding tbat the income 

 from any private consultations into wbicb 

 he might see fit to enter, sbould be added to 

 the budget of his department. Such an 

 arrangement might be regarded as a dis- 

 tinct protection to tbe professor. For the 

 financial questions which relate to practise 

 are to some annoying and disturbing. And 

 if the salary paid to the university pro- 

 fessor be in any way sufficient, I can easily 

 fancy that tbe professor might prefer to 

 have it understood that tbe income from 

 any practise which he might care to under- 

 take should go into the budget of his depart- 

 ment. I ean also fancy that others might 

 feel differently; that they might prefer a 

 complete independence, expressed or im- 

 plied, in this respect. I can further fancy 

 that the university or bospital might fear 

 that if tbe professor once began to accept 

 fees from, private patients, he would be in 

 danger of being drawn into practise to such 

 an extent that it would interfere with, his 



