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136 total budgets are but a few thousand dollars. A few dollars are expended for books; animals are provided in a gingerly manner; pathological material is small in amount, and comes as a gratuity from distant schools whose needs have been previously supplied; apparatus barely suffices for routine work; no helpers relieve the single departmental teacher of menial drudgery. These schools are of course scientifically sterile; as such, they must rapidly become antiquated, for they are situated in out-of-the-way places and their staff has but little intercourse with active centers. It seems hardly justifiable to start such ventures merely to meet institutional competition. The two-year school can doubtless make good where, as in Wisconsin, liberal support overcomes at many points the defects due to isolation; the heavy charges incurred, however, ought to be seriously pondered by those whose less ample means forbid anything like so adequate an appropriation.

It is now clear that medicine cannot be, and is not, properly taught on the basis of receipts. We have at this date 30-odd schools, all university departments, whose annual budgets call for sums considerably in advance of their receipts from fees. As these institutions will in number and facilities undoubtedly soon be equal to the task of producing physicians enough to supply the need, the coil is tightening around schools not yet in position to devote even all their fees to instruction. Well known institutions can still be cited, whose instruction as offered costs the school less than the fees paid in,—a balance being available for buildings, improvements, or for debt originally incurred for plant. Large receipts mean in most instances low standards,—standards below the four-year high school basis. In order to secure a balance, economies must be effected, as has been already pointed out, at the expense of teaching, by inadequate equipment, uneven development, lack of full-time professors, reliance upon necessarily incompetent student assistants, absence of helpers, employment of volunteers in the dispensary, etc. Tufts College Medical School, with an income of $59,095, is paying off in annual insralments a debt incurred for the building it now occupies; Jefferson Medical College, with receipts of $102,995, must incidentally accumulate a fund to retire a large mortgage. The medical department of Northwestern University must apply its surplus to the discharge of debts incurred for buildings and plant. Vanderbilt University, having invested $83,000 in a medical department, compels the department out of its fees (about $25,000 a year) to pay all its own running expenses, something on the original purchase price, and six per cent interest on the unpaid balance. The University of Maryland, the College of Physicians and Surgeons of Baltimore, the Starling-Ohio (Columbus), pursue substantially the same policy.