Page:Carnegie Flexner Report.djvu/56

38 18 per cent; in the three years following, on the basis of one year of college work, the mortality was about 10 per cent. At the University of Virginia, in the last two years on the old basis, 38 per cent of the students failed in one or more subjects; an increase in entrance requirements by one college year reduces the fatalities to 14 per cent, despite the augmented difficulty of the work. The medical department of the University of Texas has gradually advanced from a two-year high school basis to a four-year high school basis; on the lower standard there were 34 per cent of hopeless failures in 1903, as against 13 per cent of hopeless failures in 1908, on the higher. The requirement of a college year assists doubly,—first, in eliminating the sham equivalents; next, in strengthening the equipment of those who actually persist. Canada accomplishes the former by means of the examinations already noticed, with the result that the mortality there is distinctly less than ours, at something like the same ostensible level.

The breaches made by the fatalities above described are repaired by immigration, which on investigation proves to be in most instances only another way of evading standards, — entrance and other. To some extent, good students who find themselves in a poor school endeavor to retrieve their error by transferring themselves to a better; again, there is a certain amount of enforced emigration annually from schools that, like the University of Wisconsin, offer medical instruction in the first two years only. In the main, however, the "lame ducks" move, and, strangely enough, into schools that are at the moment engaged in rejecting a number equally lame. The interchange is veiled by pretended examinations; but the character of the examination can be guessed from the quality of the students that pass it. Two standards are thus often broken at once: An ill equipped student registers in a lowgrade Chicago school. At the close of a year or two, he transfers to the College of Physicians and Surgeons, which might have declined him originally. He has thus circumvented its admission requirements. If, now, he has previously failed in the medical courses so far pursued, and succeeds "on examination" in passing, he has simultaneously circumvented the professional requirements as well. Instances of both kinds abound in schools at and below the high school basis. In 1908-9 the Medico-Chirurgical College of Philadelphia accepted failures from the Jefferson Medical College and the