598 



SCIENCE 



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



ical investigation is, of all other types, prob- 

 ably the most intricate and difficult, for the 

 reason that the problems studied are of such a 

 nature that the factors entering into them can 

 not, as a rule, be varied at the wiU of the in- 

 vestigator. If, therefore, we hope to encourage 

 worthy product along the lines of scientific 

 clinical research, we must, to say the least, 

 provide the clinical teacher with an environ- 

 ment as favorable as the one with which we 

 surround the fundamental teacher. It is no 

 answer to this argument to quote the nutnerous 

 examples of epochal discoveries made by busy 

 practitioners. The superman will inevitably 

 enrich his field, in the face of compromising 

 odds or even of grueling adverse conditions. 

 The problems of education always deal with 

 averages, and what we desire to see is a system 

 attuned to producing from among the common 

 ranks of medical men a proportionately large 

 number of clinical teachers and investigators. 

 We base our hopes on the full-time plan as 

 an aid in attaining this worthy end, and all 

 seems well until we are rudely halted by the 

 oft-cited esample of Germany, the nourishing 

 mother of all that is best, and stable, and ap- 

 proved, in medical education. Germany has 

 no full-time clinical instructors, and, what is 

 more, the very men whom we all recognize as 

 her leading clinical educators have not a par- 

 ticle of sympathy with the American full-time 

 plan. Here truly is a stumbling block. And 

 yet, the explanation is not as difficult as it 

 appears to be. German clinical teachers, in 

 spite of their unqualified rights to practise, 

 have mortised themselves into medical history, 

 so that their names fairly dot pages. More 

 than that, practically every great German 

 clinical teacher has developed about him a so- 

 called school of younger men. By contrast, 

 we have at home a proportionately very small 

 number of names that even the most chau- 

 vinistic among us would set up with the 

 leaders of German clinical thought, and only 

 comparatively few of our clinical teachers have 

 grouped a school of enthusiasts around them. 

 But this contrast does not signify that the 

 German clinical professor is efficient because 

 of his uncompromised right to practise. At 

 all events, it would be difficult to establish 



proof to this effect. It seems much more likely 

 that he is efficient in spite of the fact that he 

 shoulders the distractions of practise. Indeed, 

 those who have come into intimate contact 

 with the directing heads of clinical departments 

 in Germany know that many of them reso- 

 lutely set themselves against these distractions. 

 Friedrich Mueller, of Munich, may be selected 

 as a type. Mueller considers his two-hour 

 sprechsiunde devoted to private patients, as 

 a type of relaxation, comparable to golf, 

 mountain climbing, or other forms of diversion. 

 No inducement will persuade him to lengthen 

 the office hour, and he refuses to make extra- 

 urban visits, under ordinary circumstances, 

 unless there be some teaching value inherent 

 in the call. His serious work is teaching and 

 directing, to both of which he devotes consum- 

 mate care, and consequently a large amount of 

 time. Between Mueller as a teacher of medi- 

 cine and, let us say, Marchand as a teacher of 

 pathology, there is no essential diiference. 

 They are both so-called fundamental men, each 

 in his own specialty; and Mueller represents 

 the type that the advocates of full-time in- 

 struction in America hope to develop — the 

 fundamental clinician as teacher. 



If we be asked why we concede that private 

 practise has not militated against the develop- 

 ment of the highest type of clinical teacher in 

 'Germany and has so markedly militated 

 against it in America as to call forth an edict 

 of interdiction, we can answer only that the 

 variance between German and American cul- 

 ture and traditions so profoundly infl.uence 

 thought and act as to render it impossible to 

 graft, unaltered, a system of thought from 

 one country to the other. It is likewise equally 

 impossible to argue that because certain con- 

 ditions are favorable from an educational 

 point of view in one country, they must of 

 necessity be favorable in the other. The Ger- 

 man is the type of patient plodding lover of 

 gemueilicKkeit, who, certainly up to recent 

 times, did not labor in medical fields under a 

 very heavy stress of commercial competition. 

 Tradition requires that he advance to scien- 

 tific preferment only through a dozentship, 

 and this in turn implies approved excellence 

 as teacher or producer. The American, on 



