Page:Carnegie Flexner Report.djvu/213

Rh now is on a small number of beds paid for by the city in the Hahnemann Hospital, a modern institution close by.

Date of visit: May, 1909.

of medical education in California may well start from the fact that, without taking into account the osteopaths—who abound—the state has now one physician to every 401 inhabitants, that is, in round numbers, about four times as many doctors as it needs or can properly support. Such an enormous disproportion can hardly be rectified within less than a generation; it makes radical measures in the interest of sound medical education not only immediately feasible, but urgently necessary.

Legal enactment fixing a sound basis for future practitioners, of whatever school, the grant of authority to the state board to close schools flagrantly defective in either laboratory or clinical facilities, or the institution of practical examinations for license,—any one of these measures would at once wipe out at least seven of the ten existing schools, with distinct advantage to the public health of the state. As none of these schools has the resources indispensable to meet the rising tide in medical education, this outcome is in any case inevitable; legal regulation of the type indicated would merely hasten the day.

Even then the situation of medical education in the state is not altogether clear. The University of California has not yet solved its problem. The sums it now devotes to medical education are relatively small; its clinical facilities in San Francisco are inadequate; it has not effectively organized what it there offers; it has not brought about team work between the two severed branches that constitute the department. If now it has proved difficult to perfect an organization covering two places separated by San Francisco Bay, what reason is there to be confident when the distance involved is five hundred miles? Nor does any practical need compel a step educationally questionable. The attendance in Los Angeles in the last two years on a high school or equivalent basis is less than thirty; it will fall still lower when the two-year college basis is enforced and transplantation from Berkeley to Los Angeles is required at the beginning of the third year. Moreover, the clinical prospects are by no means up to university standard. The dispensary may indeed be adequately developed, but one hundred beds in the general medical and surgical wards of an old-fashioned public hospital, however supplemented by courtesies elsewhere, constitute a fragile support for a university department of medicine. The difficulty of controlling the teaching at Los Angeles by the scientific ideals of the university at Berkeley can hardly be overstated. Finally, with the present needs of the clinical department at San Francisco, it is not likely that the university can divert to Los Angeles the sums necessary to create a satisfactory department there. The move is explained on the