Page:Carnegie Flexner Report.djvu/153

Rh University, St. Louis (178 students), spends $9640 for anatomy, $8550 for physiology and pharmacology; the University of Wisconsin (49 students) spends $10,000 for anatomy and $8100 for physiology. Anatomy costs the University of Michigan $14,300 a year, and the University of Iowa $13,525. Champions of cheapness allege that large sums are needed only for research, where medicine is taught to college graduates who afterwards practise in large cities; but Michigan and Iowa spend these sums in behalf of high school boys who after graduation from the medical school return to the simple surroundings amidst which they grew up. New York University operates also with high school boys, and is mainly a teaching school. Where clinical medicine is on the proper basis, the same result emerges: at Tulane, for example (439 students), the department, recently reorganized on modern lines, requires $9100 for its support. The University of Michigan uses $7830 in medicine, $9405 in surgery. Every one of the important subjects must of course very soon be provided on an adequate scale; for in every acceptable medical school, though large individual variations must occur, the movement to treat the main clinical divisions similarly will not stop. A simple process of multiplication will then give the minimum cost of maintaining a medical establishment in which all the essential subjects are adequately, even though not homogeneously, developed. Endowment or taxation alone can meet this burden,—and endowment and taxation are feasible only if medical education is carried on not only in, but by the university. For of course a medical school supported by fees is just as fettered inside, as it would be outside, the university. Its ideals may be higher; its fee income may be more independently expended. But in no case are the fees adequate to support all the essential departments on a substantial basis. As a rule, these schools “feature" one or two branches; the others pine. The best developed departments show what all ought to be: pathology at New York University, anatomy at Jefferson Medical College, are really strong departments; they belong to institutions dependent on fees; but to provide them, other departments must be denied anything like equal opportunity to expand.

Of course it is not to be supposed that the most expensive teaching is the best; that a department that costs $20,000 is necessarily twice as good as one that spends $10,000; it may be both scientifically and pedagogically inferior. It remains true, however, that in general the equipment and conduct of laboratories are costly; that professorial salaries are rising; that a productive teacher needs competent assistants, expensive apparatus, material, etc., and a certain margin, in case an unforeseen turn necessitate an unusual outlay. The scientist financially hampered so as to be incapable of following out surprises may miss the most valuable result of his tedious labors.

Important is it to observe that the expense does not diminish pari passu with the attendance. The formation of two-year schools has recently proceeded apace, many of them feebly equipped and poorly sustained; their initial plant costs little; their