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examination of the financial aspects of the American medical school will completely account for the conditions that have been described. It is universally conceded that medical education cannot be conducted on proper lines at a profit,—or even at cost; but it does not follow that it has therefore ceased to "pay." It is commonly represented that medical schools are benevolent enterprises, to which selfish financial considerations are nowadays quite alien. Such is not even generally the case. Our best medical schools are indeed far from self-supporting; they absorb the income of large endowments or burden seriously the general resources of their respective universities. But these institutions constitute but a small fraction of the medical schools of the country. The others pay in one or more of several ways, if "paying" is understood to mean that the fees do more than meet the expense of running the school. This use of terms is entirely justifiable; for if fees alone are inadequate to meet the running expenses of an up-to-date medical school, then the difference between actual expenditure on instruction, with its essential incidentals, and the total fee income of the school is profit, whatever the use to which it is applied. In the worst cases this sum is great and goes into the pockets of the teachers; in many others, it may not be large in any single year, though its total over a stretch of years may be quite sufficient to have altered materially the complexion of the institution. In these schools an annual balance to the good is obtained for distribution by slighting general equipment, by overworking laboratory teachers, by wholly omitting certain branches, by leaving certain departments relatively undeveloped, or by resisting any decided elevation of standards. In one or more of these ways, for example, not to go outside the Empire State, the Albany Medical School is enabled to pay some $500 a year apiece to otherwise well-to-do clinicians; the University of Buffalo to distribute "nominal sums" of $1000 to a number of professors in large regular practice; the Long Island College Hospital to apportion a substantial sum out of the fee income in tithes among the faculty; and the University and Bellevue Hospital Medical College to pay out of fees salaries to some of the most successful practitioners in New York city, while the laboratory branches still lack anything like uniform development. More favorable, but still by no means beyond the reach of legitimate criticism, is the case of schools that, admitting the impossibility of providing satisfactory instruction at cost, nevertheless save from current use a not inconsiderable amount to be applied to paying for buildings or plant instead of dividends. Every such saving is necessarily at the expense of instruction; that is to say, if every dollar taken in were consumed in current teaching, unfortunate make-shifts would still have to be employed. With every dollar less than total fee income