Page:Carnegie Flexner Report.djvu/146

128 as it could get them. They need never have been so badly trained as most of them were. But on that point it is useless to dwell. Important for us it is to ascertain whether in this year of grace, 1910, it is still necessary to put up with schools that are seriously defective; and if so, to what extent, and how much longer.

What does it really cost to carry on a medical school that construes its duty in social terms? Initial investment may be put to one side. That, the college income cannot furnish; fees cannot provide buildings and equipment in the first place, or pay for them subsequently in instalments. The medical school must start with an adequate plant, laboratory and clinical, debt free. The value of these plants may vary within very wide limits; size, style, the ratio of teaching to research, all bear on the problem of initial cost. In a measure it is a question of taste, how much one will expend on buildings and equipment. Essential, however, to every venture are class-rooms with the essential teaching paraphernalia, class laboratories in each of the sciences with individual equipment, private quarters with requisite appurtenances for each member of the teaching staff. These facilities cannot be dispensed with because the numbers to be handled are small. The several items may be scaled down, but they do not disappear. Fee income, confessedly inadequate to keep such a plant running, cannot be called on to provide it. The plant, therefore, is taken for granted before we even begin to consider what it costs to teach medicine.

For the sake of simplicity we shall continue the demarcation between laboratory and clinical branches. At present the cost of maintaining the hospital is not usually a school encumbrance. Whether or not it ought to be must be decided as the case arises. Western Reserve is in position to avoid the expense; the University of Michigan must carry it. In general, the school obligation on this point has been shirked. The intolerable compromises described in the preceding chapter are employed in consequence. Nothing will perhaps go further towards destroying superfluous schools or preventing new ones than correct ideas as to necessary hospital conditions. It is quite impossible that most schools should either possess their own hospitals or effect a satisfactory relation with hospitals belonging to other people. At the moment, possession rather than diplomacy seems in most places to furnish the only satisfactory solution, —and possession necessitates an immense increase of the school budget. Meanwhile, this point will not be obscured by provisional separation of the two budgets; for this manner of presentation an additional reason is found in the fact that, to a varying extent, the hospital may be made to carry itself without derogating from its pedagogical purpose.

A schematic outline of the laboratory years calls for at least five departments, (1) anatomy, (2) physiology and pharmacology, (3) chemistry, (4) pathology, (5) bacteriology and hygiene, subject, within limits, to rearrangement. The ultimate cost of the entire school will not be greatly affected by such redistribution. In their internal economy the departments will follow the same general lines. There will be a professor, devoting himself wholly to teaching and research, and in position to do both;