May 19, 1916] 



SCIENCE 



703 



university or hospital work. But, as I have 

 said, the question of what becomes of the 

 professor's fees seems to me of limited im- 

 portance — a detail in connection with the 

 larger problem. I can not see in it a great 

 question of principle. 



So far as the student goes, the danger 

 that under the direction of a salaried pro- 

 fessor, he may be given a training more 

 purely academic and insufficiently prac- 

 tical seems to me small. In the first place, 

 it has already been pointed out that the 

 professor of medicine will doubtless be a 

 man who has had a considerable clinical 

 experience with patients in all classes of 

 life, whose training has been by no means 

 purely academic, and although some of his 

 associates will perhaps be men who have 

 not yet acquired the ripened experience 

 which should be that of the head of the 

 department, yet no one for a moment fan- 

 cies that all the instruction in medicine and 

 surgery will be given by the nucleus of 

 teachers wholly dependent on their salar- 

 ies. In every large clinic, and in every 

 large hospital affiliated with a university, 

 a considerable part of the instruction in 

 general medicine and surgery, as well as in 

 specialties, must be entrusted to men with 

 or without salaries, who are more or less 

 actively engaged in practise. The fancy 

 that because the director of such a clinic 

 and many of his assistants are no longer at 

 the beck and call of the public, the student 

 is to be regarded as deprived of the oppor- 

 tunities offered by association with men 

 who have been or are engaged in active 

 practise, is a misconception. 



That which the reorganization of a clinic 

 upon a university basis should do, how- 

 ever, is to bring it about that the practi- 

 tioners who share in the work and advan- 

 tages of the hospital and take part in the 

 instruction may be rather more carefully 

 aud wisely chosen than they have been in 



the past. Well-digested experience, merit 

 and teaching ability should more clearly 

 and surely be recognized by a director un- 

 trammelled by hospital traditions and bent 

 solely on the improvement of his clinic. 



The experienced clinician who is still 

 engaged in private or consulting practise, 

 if he be a man of high order, is not likely 

 to lose his touch with the hospital or with 

 the clinic so long as he is able and desirous 

 of giving it his services. Indeed, it is prob- 

 able that in the future, institutions will re- 

 tain a closer connection with some of the 

 members of the staff who are engaged in 

 private consulting practise by offering 

 them the privileges of consulting rooms at 

 the hospital. This plan, which has already 

 been adopted in some instances, ought to 

 be of great mutual advantage to hospital, 

 to physician and to patient. To the hos- 

 pital because it brings into close connec- 

 tion with the clinic those examples of rare 

 and unusual disease which are sent to the 

 consultant; to the physician because he is 

 able to give much more time to his work at 

 the hospital; to the patient because if the 

 consulting room of the physician be at the 

 hospital center, the many accessory exami- 

 nations which so often have to be made, 

 can be carried out much more expedi- 

 tiously. But if such a physician be en- 

 gaged in active consulting practise, he will 

 no longer be the director of the clinic, and 

 this, as has been pointed out, would seem 

 to be desirable from every standpoint. For 

 only under exceptional circumstances can 

 such a man command the time necessary 

 properly to direct a full department. 



How much or how little time the head of 

 a department of medicine or surgery may 

 give to consulting practise is, however, a 

 question which in the end must depend en- 

 tirely on the character of the man. He 

 may give very little of his time; he may 

 give a good deal. But if he be a man 



