April 23, 1915] 



SCIENCE 



595 



school-day to the management of his depart- 

 ment, who shall receive an adequate compen- 

 sation for his highly specialized labor, and 

 who shall be protected against the inevitable 

 lures and enticements incident to his position, 

 by a provision which denies him the right to 

 accept private fees, or permits him to accept 

 them only on such conditions as may be im- 

 posed by the university. This is the simple 

 statement of the case. And as the question 

 stands at present, its importance resides not 

 in the working out of a detailed scheme of 

 clinical instruction under such a plan;^ but 

 rather in formulating a critical judgment re- 

 garding the advisability and practicability of 

 so modifying our method of clinical instruc- 

 tion as to make it conform to other approved 

 methods of education. 



And when we have said this we have 

 hinted at one of the most paradoxically inex- 

 plicable phases of medical education. It may 

 be stated that, almost without exception, clin- 

 ical teachers realize the essential necessity for 

 full-time men in all of the fundamental 

 branches of medicine. The very canons of 

 education demand such a system. Yet, a 

 large number of these same clinical teachers 

 assume that there is such a wide divergence 

 between the teaching of the fundamentals and 

 of clinical medicine, as to render wholly un- 

 warrantable the conclusion that clinical teach- 

 ing also should be based on that plan which 

 alone is best suited for instruction in funda- 

 mentals. It is, for very self-evident reasons, 

 natural that the scheme for full-time clinical 

 instruction should have the strong support of 

 most of the teachers of the fundamental 

 branches. It is not so easy to explain the fact 

 that opposition to the plan has come so largely 

 from clinicians. Such a clean-cut division 

 into camps is unfortunate, because it has set 

 in motion a controversy tinctured with bitter- 

 ness. The so-called laboratory men are 

 charged with a tenacious hold on impractical 

 ideals, limited by virtue of a narrow occupa- 

 tional horizon; and the clinicians are, in their 



2 Details of organization are purposely omitted, 

 such, for example, as the number of full-time sal- 

 aried assistants necessary to the successful con- 

 duet of a department. 



turn, supposed to typify the old story, re- 

 peated in myriads of forms, of privilege cling- 

 ing to tribute. Neither of these assumptions 

 is entirely correct ; both of them are essentially 

 harmful because they drag the argument 

 down to the low level -of personalities. Dis- 

 agreements of this sort usually rest on fal- 

 lacious judgments. An unqualified advocate 

 of the full-time clinical instructor, I have, for 

 the past few years, noted various fallacies, 

 patent or concealed, in the arguments against 

 this plan of instruction; and the only object 

 of this contribution is to examine these vari- 

 ous fallacies, with the hope of clarifying a 

 fairly well-confused topic. 



Of all others, the fallacy most responsible 

 for both bitterness and confusion is the as- 

 sumption that full-time clinical instruction 

 connotes a clean sweep, displacing all teachers 

 who are private practitioners and replacing 

 them by non-practitioners. Such a plan has 

 the advocacy of no one. Barker, in his ad- 

 dress on " Tendencies in Medical Education," 

 falls into this particular fallacy when he de- 

 velops the thought that " the present incum- 

 bents of clinical chairs " by virtue of " the 

 rightfulness of the kind of work done by 

 them '' hold their positions in " good faith." 

 He pleads the cause of these " honest, hard- 

 working men " in such fashion as to warrant 

 the inference that they are all to be displaced, 

 and that their displacement is a breach of 

 moral contract on the part of the university. 

 Dr. Barker certainly does not, nor should any 

 one else, minimize the value of such services 

 as are rendered at Johns Hopkins University, 

 for example, by those clinical men who are 

 not on a full-time basis, simply because at 

 that university there are academic heads to 

 medicine, surgery and pediatries. It is su- 

 premely important to recognize the fact that 

 the varying character of clinical material wiU 

 always make it both advisable and necessary 

 for the university to ofier place and preference 

 to the properly qualified clinical teacher, irre- 

 spective to his affiliation with private prac- 

 tise. The full-time clinical instructor, to- 

 gether with his staff, is a necessary adjunct 

 in organizing, coordinating and correlating 



