594 



SCIENCE 



[N. S. Vol. XLI. No. 1060 



plete and satisfactory graphic representa- 

 tion is scarcely to be expected. "We can 

 agree at least that progress is being made 

 toward such an understanding. 



Francis P. Venable 



SOME FALLACIES IN THE ARGUMENTS 

 AGAINST FULL-TIME CLINICAL 

 INSTBUCTIOm 

 In a recent paper, published in. Science, 

 Dr. S. J. Meltzer comments upon two notable 

 facts in connection with the present rather 

 active agitation regarding full-time clinical 

 instructors. The two facts singled out by 

 him are: (1) The appointment of full-time 

 professor of medicine, surgery and pediatrics, 

 by the Johns Hopkins University, and (2) 

 the disparagement of this type of plan by the 

 council on medical education of the American 

 Medical Association. Dr. Meltzer's paper 

 itself constitutes a third notable fact, in that 

 it represents one of the very few unqualifiedly 

 strong appeals that have been made by a cli- 

 nician in favor of full-time clinical instruc- 

 tion. Although engaged at present in a so- 

 called fundamental research, the current of 

 Dr. Meltzer's life has been clinical to so large 

 a degree, that his conclusions can not be 

 questioned on the ground of academic im- 

 practicability. He analyzes the report of the 

 council with logical seriousness; and were it 

 not for the artifice of a single italicized word, 

 one would scarcely feel the flick of Meltzer's 

 lash or realize the seriousness of the attempt 

 of the council to laugh the case out of court. 

 Dr. Meltzer, by rare grace and tact, forges an 

 argument so uncommonly well tempered as to 

 render supportive discussion almost unneces- 

 sary. And yet, if there be any force in the 

 plea for full-time heads of clinical depart- 

 ments, it lies in the line of duty of those of 

 us who are clinicians to develop its full 

 strength by discussion. 



In such a discussion, as indeed in all such 

 discussions, nothing contributes so much to 

 balance and rationality as does a proper con- 



1 Read before the twenty -fifth annual meeting 

 of the Association of the American Medical Col- 

 leges, Chicago, February 17, 1915. 



ception of the historical perspective of the 

 problem involved. It is essential to realize 

 at the outset that the question is not a new 

 one involving American medicine alone. 

 Many men would have us believe that sud- 

 denly, as a result of this, that, or the other 

 tendency, our clinical instruction in America 

 has been found wanting, and that with typical 

 American impulse we have set to moving in 

 the sacred realm of education, the machinery 

 of experiment. As early as the seventeenth 

 century, Leibnitz attempted to justify his 

 faith in quacks, on the basis that doctors were 

 improperly trained as men of science, and that 

 it was hopeless to look for the development 

 of scientific teachings and methods in a prac- 

 titioner, der nichis thut als von einem Pati- 

 entem zum andern rennen, und wenn er hey 

 dem einen isi, auff den- andern schon denhet 

 (who does nothing but run from one patient 

 to another and who, when he is visiting one 

 patient, is already thinking about the next 

 one). Almost a half century ago Billroth 

 anticipated the Flexner report on Medical 

 Education, in his "Ueber Lehren und 

 Lernen," a work necessarily less modern in 

 tone than Plexner's, less broad in the geo- 

 graphical consideration of the subject, but 

 not a whit less emphatic in the assertion of 

 corrective principles. Coming down to more 

 modern times, we have the Eeport of the 

 Eoyal Co mm ission on University Education 

 in London (1913) in which it is admitted that 

 " the academic training received by medical 

 students in London has not always been dis- 

 tinguished, and that the scientific spirit has 

 been too often wanting." "We in America have 

 also found that, even in our best schools of 

 instruction, the scientific spirit has been too 

 often wanting, and we have found it wanting 

 chiefly in the clinical branches. On this basis 

 rests the agitation for full-time clinical in- 

 struction. 



The phrase " fuU-time clinical instruction " 

 signifies that the teaching of each major 

 clinical subject be under the supervision of a 

 properly qualified instructor, who shall serve 

 as the head of his department, who shall de- 

 vote all his energies during the working 



