respective sciences, in their general relations; the latter is part of the routine machinery of the hospital. To suffice for clinical investigation the laboratory staff must be so extended as to place, at the immediate service of the clinician, the experimental pathologist, experimental physiologist, and clinical chemist in position to bring all the resources of their several departments to bear on the solution of concrete clinical problems. Of these branches, experimental pathology and physiology have already won recognition; the next step in progress seems to lie in the field of clinical chemistry, thus far quite undeveloped in America.
It follows that in other respects, too, the clinical professors will be on the common university basis: salaried, as other professors are. Of course, their salaries will be inadequate, i.e., less than they can earn outside, –all academic salaries paid to the right men are. But there is no inherent reason why a professor of medicine should not make something of the financial sacrifice that the professor of physics makes: both give up something—less and less, let us hope, as time goes on — in order to teach and to investigate. The clinical teacher should indeed not arbitrarily restrict his experience: he may wisely develop— preferably in close connection with the hospital—a consulting practice, assured thus that his time will not be sacrificed to trivial ailments. On the same basis, other university facilities are at the service of those who require unusually skilful aid; for at all points only good can come of educational contact with unsolved problems,—practical or other. But a consulting practice—developed in a professional or commercial, rather than in a scientific spirit—may prove quite as fatal to scientific interest as general practice. University hospitals, academic salaries, etc., make the conditions in which clinical medicine may be productively cultivated. They do not create ideals; and without ideals, superabundant and highly paid consultations are perhaps as demoralizing as superabundant low-priced "calls."[1]
The financial resources at this moment available are far from adequate to provide hospitals exclusively and continuously the laboratory of the clinical departments of medical schools, and faculties composed in the first place of scientific teachers of clinical medicine. Twenty-five years ago as much would have been said in reply to a plea for thirty medical schools each equipped with a complete set of scientific laboratories. When the number of our medical schools is once reduced to our actual requirement, the sum involved in properly equipping them with hospitals will not appear impossibly formidable. Meanwhile, existing hospitals may well enlarge their teaching facilities, where such facilities are open to a high-grade student body. Nothing is clearer than that an intimate relation to medical education properly carried on is to the advantage of all concerned,—to the larger public, by producing better physicians, to the patient, by procuring for him more competent attention. On this point there is no room for doubt. "I speak after an experience of nearly forty years,"
- ↑ See, for example, Graham Lusk: "Medical Education." Journal Amer. Med. Assn., April 17, 1909, pp. 199, 130, and S. J. Meltzer, "The Science of Clinical Medicine," ibid., August 14, 1909, pp. 508-12.
