Page:Carnegie Flexner Report.djvu/158

140 the hammer, bring $500. The St. Louis College of Physicians and Surgeons, with an estimated income of $16,035, cannot afford the simplest equipment for its squalid dispensary and its hopeless laboratories. The osteopaths bid fair to repeat the worst offenses of the medical practitioners: their schools are fairly booming. The receipts of the Kirksville institution probably reach $89,600 a year. The instruction furnished is exceedingly cheap in quality. All in all, there are annually paid in the United States and Canada about $3,000,000 in medical student fees. An equal sum has been paid annually for years. It is obvious that only a small part of the total fee income of our medical schools has been devoted to upbuilding and equipping the schools, though just the reverse is pretended. Undoubtedly, the disfavor with which educational benefactors have regarded medical education is justified by the mercenary record reflected in these figures. But it is highly important that henceforth distinctions be made.

There are in the United States and Canada 56 schools whose total annual available resources are below $10,000 each,—so small a sum that the endeavor to do any. thing substantial with it is of course absurdly futile; a fact which is usually made an excuse for doing nothing at all, not even washing the windows, sweeping the floor, or providing a disinfectant for the dissecting-room. There is not a shred of justification for their continuance: for even if there were need of several thousand doctors annually, the wretched contribution made by these poverty-stricken schools could well be spared. Among them may be mentioned the California Eclectic (Los Angeles), estimated income $1060;Pulte Medical College (Cincinnati), estimated income $1325; Toledo Medical College, with $3240; Willamette University, with $3580; and Southwestern Homeopathic College, with $1100.

Responsibility for the conditions described does not rest on medical men alone; colleges and universities have not infrequently become accessory after the fact. We have repeatedly urged that the proper place for a medical school is within a university; but there is no saving grace in the mere name. Three services may be specified as comprised in the duty of a university which makes itself responsible for a medical school: the definition and enforcement of entrance standards, the upholding of scientific ideals, and responsibility for adequate support. We have mentioned universities that fail in the first or the second or in both; and as a rule these are the institutions that fail likewise in the third. Of the 155 medical schools of the continent, 82 are university departments, actual or so-called. With few exceptions the connection of these universities with medical education began at a time when no one took obligations in the matter seriously. Some of those that entered the field thus lightly have made amends. Others, awakening late to a sense of their obligations, are confronted by an apparently hopeless situation. Their total annual income would not alone suffice for a good medical school,- and it must carry the burden of the entire