"sized up," and thoroly. Personal bearing and character will affect the final reckoning without doubt. On all counts, then, Americans may look forward to the Oxford Ph.D. as an award indicative of real merit, certain to carry weight. It may take them some time to realize that this is likely to be as true of a degree earned in the sciences as of one earned in the humanities. It may also take them some time to realise that Oxford has much to give thru association with men and customs, and thanks to a perspective from which fancies and delusions have been eliminated by the chastening influence of splendid memories. Above all, they may learn in the grey, old city what they so much need to learn that Otio qui nescit uti, plus negoti habet, Quam cum est negotium in negotio. For the man himself ought to be a product incomparably more important than any dissertation, his personal equation far more significant than any degree. Indeed, if Oxford remain true to herself, we may hope that her new Doctorate will be impossible of attainment by anyone who, despite external marks, continues to evince so little intellectual experience as to be, in the things of the mind, no better than an industrious peasant. UNIVERSITY OF MICHIGAN R. M. WENLEY 1 IV OUTSIDE PROFESSIONAL ENGAGEMENTS BY MEMBERS OF PROFESSIONAL FACULTIES1 In order to economize time for the fuller discussion of matters about which we may differ, I shall assume at the outset that we all substantially subscribe to the following seven propositions: 1. That professional faculties for the purpose of this discussion shall be limited to the professional faculties of universities, and that extra-university medical schools are not in consideration. 2. That the essential distinction between a university teacher and a teacher in a secondary school or college resides in the obligation which rests upon the former to advance knowledge in his subject, in addition to imparting knowledge. 3. That the essential distinction between a university student and a school boy or college student lies in the fact that the former aims to become a worker in his chosen subject and, therefore, seeks training in methods, whereas the latter, if he has any interest in learning at all, seeks knowledge about the subjects studied as a means to general culture. In this aim students in technical schools and professional schools are one with the Ph.D. students of philosophical faculties. On the other hand, in American institutions with graded courses of instruction and rigid separation of students into classes, the professional student can not choose his teacher in each individual subject, but can only choose a group of teachers in the subjects taught in one or more years of the course. In this respect the professional school is midway between the undergraduate and the graduate school, whatever its requirements for entrance. Only after he has obtained his professional degree can the student of medicine choose his own masters. 4. That the inclusion of a member of a medical faculty in this discussion is evidence of a consciousness that, in the medical schools of the United States, professors have in the past far too 1 A paper read at the annual meeting of the Association of American Universities, at Iowa City, Iowa, November 10, 1917. Dr. Janeway died after a brief illness on December 27, 1917. frequently fallen below university standards and have been successful practitioners first, teachers second; also that this condition is anomalous, that its cause should be sought and a remedy found. 5. That the professors in the fundamental medical sciences, the so-called pre-clinical subjects of the first two years of the medical course, anatomy, physiology, biological chemistry and bacteriology, are university professors of pure science assigned to the medical faculty, and that the problem of outside professional engagements for them is practically non-existent. 6. That the ideal medical school should have men of equally true university type in the practical clinical chairs, medicine and surgery, with their special branches, and obstetrics; that these men should be recognised masters of their subjects, contributing actively to their advancement, stimulating their assistants and students to independent research, epitomising in their teaching the best existing thought, but always suggesting the unsolved problems for the future and arousing enthusiasm for honest work toward their solution. This attitude of mind it is which Claude Bernard, seventy years ago, told his pupils distinguished the lectures they would hear from him from the didactic teaching of the clinical professors at the faculty. 7. That, with this constructive aim in view, the object of the present inquiry is to determine whether outside professional engagements for clinical teachers constitute an obstacle to its realization, and to what degree. Let us now examine a little more in detail what the realization of this ideal demands of professors of medicine or surgery. First, they must be masters of their subjects. These subjects are practical arts as well as applied sciences. The physician, therefore, must be a skillful diagnostician, and command both the technic of modern treatment and the wisdom of his more scantily armed predecessors. The surgeon must be a dextrous and resourceful operator, the obstetrician an accomplished midwife. Only long practical training can make them masters, and only constant application of their knowledge can keep them such. They must be men of sound judgment based on long personal experience, whose opinions are valued in difficult cases. These qualities are not acquired in the laboratory, but at bedside and operating-table, and in the post-mortem room, for every master of medicine or surgery must also be a good pathologist. On the other hand, they must be investigators. Today this requires first-hand familiarity with the exact methods of laboratory science, of physiology, or chemistry or bacteriology, as applied to the study of disease in man. The days when new knowledge might be acquired thru the exact description and record of symptoms and signs, a method which has made so many men famous, since Laennec and Louis and Bright, are not wholly outlived; but great advances can not now be made without the methods of exact science. The education of the laboratory, therefore, must also be acquired, and the time-consuming investigations of the laboratory must be carried on, or the clinical master will be a sterile professor. Furthermore, the professor must have a reasonable acquaintance with the history of his subject and must keep abreast of its enormous literature, if he would be true to university type. In the education of such a clinical master, and his education is never finished, what is an outside engagement? Strictly speaking, there can be none. "Nihil humanum mihi alienum puto❞ may for him be rendered. "No phase of human disease is without significance for me." On the other hand, it is clear that only the exceptional Superman can survive such an education, and that for the ordinary ruck of mortals, for from such most university professors must, after all, be chosen, limits must be set somewhere. It is thus a question of balance, of Aristotle's "mean." Nevertheless, one aspect of this threefold activity I must insist on as fundamental for every clinical teacher: he must be a practitioner of his branch of the medical art. If not, no matter how able an investigator he be, he is not a clinician. The subject-matter of his investigation must be the sick human being, and his essential workshop the hospital. Even tho he may often resort to more easily-controlled experiments on the lower animals for help in the elucidation of his problems, no solution is final until his experiment has succeeded in curing the sick man. The hospital is also his classroom. Only in dispensary, ward or operating-room, can he train the student in the methods of investigation and treatment of patients, and familiarize him with the natural phenomena of disease. Such training we have already agreed is the essence of professional or university education. Since the hospital is both classroom and workshop, the clinical teacher is obliged to carry the heavy responsibility of its professional administration, making it contribute the most possible to the care and cure of the patients within its walls, to the instruction of the students who contribute to this care, and to the discovery of new facts or the elaboration of improved methods. He must have, as accessory to his wards, laboratories of chemistry, microscopy, bacteriology and applied physiology, for investigation, and must oversee the work done in them. If a surgeon, he must organize the complicated machinery and team-work of an operating-room and conduct a pathological laboratory for the study of diseased tissues removed at operation. Thru it all he must bear the responsibility for human lives committed to his care, with their immediate, and often urgent, problems. Thus a radical difference exists between the clinical teacher and the teacher of pure science. The former must be ready at all times to subordinate ultimate scientific achievement to the present and pressing human problem, and, unless he is willing to do this, he has no right in the clinic, but should be a laboratory worker only. He can never have the freedom nor the leisure of the latter, and mastery of his practical art must be his first care. For such a teacher, let us ask again, be he physician or surgeon, what constitutes an outside professional engagement? Since this question has come to be asked insistently in our own country, two answers have been given to it: first, that it is any engagement outside of his hospital; second, that it is any engagement for which he receives compensation additional to his salary from the university. Based on these answers two plans have been devised for restricting the activities of the clinical teacher in order to secure his undivided attention to his university and hospital duties. All |