Page:Carnegie Flexner Report.djvu/188

170 whose records entitle them to live. Of such overwhelming importance, indeed, is the character of the license examination that, if thorough practical examinations were instituted, all the other perplexing details we have discussed would become relatively immaterial.

How far we now are from this ideal realized in other countries, hardly aspired to in America, a few facts make plain. In 1906, the worst of the Chicago schools—a school with no entrance requirement, no laboratory teaching, no hospital connections—made before state boards the best record attained by any Chicago school in that year. This school, essentially the same now as then, has only recently been declared “not in good standing” with the state board of Illinois. Everywhere in Canada and the United States wretched institutions refute criticism by pointing to their successful state board records. Halifax and Western University candidates pass in Canada side by side with students from McGill and Toronto, though not in an equal proportion; for even in the written examination, better opportunities tell in the long run. Good didactic teaching at Bowdoin or Dartmouth proves capable of satisfying examinations that should strongly stress clinical experience. One or two of the states have latterly begun to introduce certain practical features into their examinations. These timid beginnings are hopeful signs, as yet, however, hardly extensive enough anywhere materially to affect either the kind of teaching employed or the outcome of the examination. The army and navy have gone a little further towards developing a practical examination than has any state board; and their written tests are probably also more severe; with the result that between the years 1900 and 1909, 46 per cent of graduated doctors applying for the naval medical corps failed; between 1904 and 1909, 81 per cent of the applicants for the Marine Hospital service failed; and out of 1512 candidates for the army medical corps between 1888 and 1909, 72 per cent failed: this, although very few of the applicants examined came from the unmitigatedly bad schools.

To do their duty fully, the state boards require to be properly constituted, organized, and equipped. At present none of them fulfils all these conditions. In consequence it is difficult to know where to lodge responsibility. In some states the law is so weak that a board can be successfully “mandamused” the moment it raises a finger. Elsewhere, a good law is practically negatived by the inactivity, if not worse, of a board that excuses itself by the apathy of the public or by the "pull" of the medical schools. In general the boards have not been strongly constituted. In many states appointments are regarded as political spoils; quite generally teachers are ineligible for appointment. It happens, therefore, that the boards are sometimes weak, and either unwilling to antagonize the schools or legally incapable of so doing; again, well meaning but incompetent; in some cases unquestionably neither weak nor well