Apeil 23, 1915] 



SCIENCE 



597 



attack or argument, for tlie very reason that 

 the majority of clinicians do not (and very 

 properly do not) use their private patients as 

 teaching material and could not even if they 

 were so minded. 



And all this leads up to another false as- 

 sumption. It is argued that since from the 

 standpoint of medical education, so little store 

 is laid by a man's capacity to gain and hold 

 the medical confidence of a large clientele, and 

 to serve it intelligently and -weO., it necessarily 

 follows that the role played by the private 

 practitioner is less ennobling than that of his 

 fellow who elects to be exclusively a clinical 

 teacher. The practising physician very nat- 

 urally resents such an inference. In reality, 

 any conclusion which sets a comparatively 

 lower value on the services of the private prac- 

 titioner than on those of the exclusive clinical 

 teacher, by reason of the fact that material 

 remuneration is greater in one field than in 

 the other, is a non sequitur. Certainly all 

 thinking men realize that between the spirit 

 of practise and the spirit of teaching there is 

 no essential ethical difference. The value of 

 effort in either field is directly proportional 

 only to the grade of intelligence and purpose 

 back of it. But between the demands of prac- 

 tise and the demands of teaching there is a 

 variation so pronounced, qualitatively and 

 quantitatively, as practically to preclude the 

 proper performance of both these functions by 

 the same individual. The full-time plan, 

 therefore, rests upon this very rational con- 

 ception of the case, and implies absolutely no 

 measure of comparative worth between the 

 vocations of practitioner and teacher. 



In the teaching of such eminently practical 

 branches as law, engineering, commercial 

 chemistry, and other technical specialties, the 

 need of the full-time instructor has been recog- 

 nized and met. There seems to be nothing 

 specifically so different in the practise of medi- 

 cine as to demand that it be regarded as an 

 exception in the general field of education. On 

 the contrary, the teaching of clinical medicine 

 demands the services of unattached men more 

 urgently than does the teaching of any other 

 practical art or science, because the two purely 

 physical elements of time and fatigue enter so 



intimately into the problem. Barker has em- 

 phasized the overwhelming amount of corre- 

 lated knowledge to be appropriated by the clin- 

 ical teacher of to-day; an amount of data 

 almost sufficient "to suffocate" him. This 

 process of appropriation requires, in addition 

 to intelligence, a very definite number of hours 

 and minutes each day. An active practise 

 rarely grants the necessary surplus of time. 

 If, however, by a process of "speeding up," 

 the practitioner succeeds in cleaning his slate, 

 in order to fulfil his teaching obligations, he 

 is very apt to find himself face to face with 

 that other disturbing physical element — fatigue. 

 It has always seemed a remarkable fact that 

 the study of fatigue in its relation to effi- 

 ciency should have been confined to the indus- 

 tries. We accept as true the fact that more 

 than a given number of hours in his cab 

 renders the locomotive engineer an unsafe 

 person to diilerentiate between the two prim- 

 ary colors red and green ; but we have to prove 

 by argument that the busy surgeon can 

 shoulder the enervating duties that confront 

 him day and night, and still be fit for one of 

 the keenest of all mental disciplines — the 

 proper teaching of science. 



And let us pause here just long enough to 

 emphasize this word science in its relationship 

 to clinical medicine. Wot the least significant 

 of the various fallacies that we are examining 

 is the one that has to do with the thought that 

 the fundamental man must be a specialist, and 

 must be on a full-time basis because, although 

 of course he is a teacher, he is also an inves- 

 tigator and must therefore have the necessary 

 time for scientific research. By inference 

 again we are subtly led to believe that scien- 

 tific research is confined to anatomy or physi- 

 ology or one of the other cognate fundamental 

 branches of medicine, and that it need not be 

 reckoned with in considering the teaching of 

 the clinical branches. Those who favor the 

 plan of full time clinical instruction are in- 

 fluenced in no small part by the hope that 

 the properly qualified clinical teacher, favor- 

 ably situated, will foster, stimulate and direct 

 scientific clinical research of a higher order 

 than is commonly produced under our present 

 system of conducting clinical teaching. Clin- 



