NEW YORK, Sunday—I spent last Thursday visiting the Rip Van Winkle Clinic in Hudson, N.Y., which was set up to try to answer some of the problems of rural medicine. This clinic, whose medical director is Dr. Caldwell B. Esselstyn, is now six and a half years old, and is an interesting example of group practice with branch centers in a rural county.

The purpose of the clinic is to make available to rural communities the best medical care at a cost which at least 90 per cent of the people can afford. To do this, of course, it is necessary to create an atmosphere that will attract well-trained young physicians to rural areas.

In my childhood I lived just south of the Columbia County line, and I am very familiar with some of the problems of this area of the Hudson Valley. The county, which is 35 miles long and about 25 miles wide, has a population of 42,000. The income of the area is derived largely from dairying and fruit farming. There are some mills and small industries. The roads are good and are kept open in winter. The level of income among the farmers is perhaps a trifle larger than in some of the other counties of the state.

Care was taken not to disrupt the security of the already existing medical economic structure of the county. Those belonging to the group practice clinic replaced older physicians or physicians who were leaving. They did not come in as new competition.

The hospital in Hudson had to be made adequate before the clinic could function. A generous grant under the Hill-Burton bill made it possible for the county, with additional private contributions from individuals and foundations, to have a modern, fireproof hospital with 140 beds.

We first went through the clinic in Hudson. It is an old house taken over and rearranged to meet the needs of a medical building. An addition is now going up. Then we visited the hospital.

The staff at the clinic consists of two surgeons, an obstetrician, medical men, dentists, a psychiatrist and various other specialists. Each has an office, from which they go out on stated days to the two branches already established in Hillsdale and Philmont. A new branch in Germantown will be established by July.

For the first time, the people of Columbia County are getting complete medical care at a reasonable cost. The doctors are all on a salary basis. A young doctor is in each of the outlying branches, but all the specialists rotate. It is one of the most exciting achievements in medical care for this type of community, and it seems to be very satisfying to the medical men themselves.