Page:Carnegie Flexner Report.djvu/40

22. Under such a régime anybody could, as President Eliot remarked, "walk into a medical school from the street," and small wonder that of those who did walk in, many "could barely read and write." But with the advent of the laboratory, in which every student possesses a locker where his individual microscope, reagents, and other paraphernalia are stored for his personal use; with the advent of the small group bedside clinic, in which every student is responsible for a patient's history and for a trial diagnosis, suggested, confirmed, or modified by his own microscopical and chemical examination of blood, urine, sputum, and other tissues, the privileges of the medical school can no longer be open to casual strollers from the highway. It is necessary to install a doorkeeper who will, by critical scrutiny, ascertain the fitness of the applicant: a necessity suggested in the first place by consideration for the candidate, whose time and talents will serve him better in some other vocation, if he be unfit for this; and in the second, by consideration for a public entitled to protection from those whom the very boldness of modern medical strategy equips with instruments that, tremendously effective for good when rightly used, are all the more terrible for harm if ignorantly or incompetently employed.

A distinct issue is here presented. A medical school may, the law permitting, eschew clinics and laboratories, cling to the didactic type of instruction, and arrange its dates so as not to conflict with seedtime and harvest; or it may equip laboratories, develop a dispensary, and annex a hospital, pitching its entrance requirements on a basis in keeping with its opportunities and pretensions. But it cannot consistently open the latter type of school to the former type of student. It cannot provide laboratory and bedside instruction on the one hand, and admit crude, untrained boys on the other. The combination is at once illogical and futile. The funds of the school may indeed procure facilities; but the intelligence of the students can alone ensure their proper use. Nor can the dilemma be evaded by alleging that a small amount of laboratory instruction administered to an unprepared medical student makes a "practitioner," while the more thorough training of a competent man makes a "scientist." At the level at which under the most favorable circumstances the medical student gets his education, it is absurd to speak of an inherent conflict between science and practice. We shall have occasion later to touch on the relation of teaching and