38 



SCIENCE 



[N. S. Vol. XXXVIII. No. 967 



cure of the sick. It must be remembered, 

 however, that the university professor of 

 clinical medicine is not the less a physician 

 because he is a man of science, and he ac- 

 quires much of his knowledge in his treat- 

 ment of the sick, although it may be ad- 

 mitted that the social range of his experi- 

 ence will be to some extent limited if it is 

 confined to hospital work. The commission 

 is inclined to think that the student whose 

 sympathy is aroused by the condition of 

 the hospital patient, irrespective of his so- 

 cial station, is the man who will work best 

 under the conditions of private practise. 



The experience of human nature, valu- 

 able though it may be, is not the only or 

 even the chief advantage of private prac- 

 tise. To a limited extent, at any rate, it is 

 said, on good authority, to be of scientific 

 and professional value for the following 

 reasons : 



First, it trains the physician to distin- 

 guish with great accuracy between serious 

 diseases and trifling ailments. The pa- 

 tients in the wards of a hospital have gone 

 through a sifting process before admission, 

 and the physician may generally assume 

 that an admitted case is a case of serious 

 illness, and his diagnosis is very much in- 

 fluenced by this knowledge. He may have 

 to determine whether a patient is suffering 

 from ulceration of the stomach, let us say, 

 or it may be from cancer; but it does not 

 matter much to the patient at the moment 

 whether it is the one or the other. He is 

 treated as seriously ill, and the treatment 

 is such 'that even if the true diagnosis is not 

 reached at once no great harm is done. 

 But in private practise the great majority 

 of cases that come before a doctor are cases 

 of trifling ailments, and he is in danger of 

 making fatal mistakes. If nine out of ten 

 patients who complain of frequent internal 

 pain are suffering from indigestion there is 

 danger of failing to diagnose cancer in the 



tenth case, and the delay resulting from 

 the mistake may be fatal. Experience of 

 this risk leads to more careful observation 

 and finer discrimination of symptoms. 

 Secondly, it is in private practise that a 

 physician has opportunities for the scien- 

 tific observation of the earlier stages of dis- 

 ease. In the case of most patients admitted 

 to the hospital the earlier stages are past, 

 and the physician only hears the descrip- 

 tion of a case given by the patient himself, 

 or by the general practitioner who has at- 

 tended him. In both these cases, however, 

 it is the general practitioner who acquires 

 the kind of experience described, rather 

 than the consulting physician, who is at 

 present the hospital teacher. On the other 

 hand, if the out-patient department of a 

 general hospital is properly and seriously 

 made use of, it aiJords great opportunities 

 for acquiring this kind of knowledge and 

 experience. 



However, private practise has a tend- 

 ency to make the physician consider the 

 patient more than the disease, and for this 

 reason it is of benefit to the teacher of 

 medicine, and therefore he should not be 

 prohibited from engaging in it to a certain 

 extent. The amount of private practise 

 would be limited by the work he had to do 

 in the hospital together with the claims on 

 his time by his own research if he were the 

 right sort of a man. Of course there would 

 be urgent cases which might be difficult to 

 disregard. The commission meets this diffi- 

 culty as follows: 



One way of dealing with a call of this 

 kind is to attend it only if the case appears 

 to be one in which the professor is specially 

 qualified to be of use, and then to accept 

 no fee. This may sound a hard condition, 

 and it would be so if externally imposed, 

 but so powerful is the attraction of scien- 

 tific work that we understand this is a self- 

 imposed condition in the case of some ex- 



