THE PRESENT ASPECT OF MEDICAL EDUCATION. 593 



still, it is well to bring a student face to face with at least one patient 

 before intrusting him with a diploma and license to practice at large. 



But practical work, at its commencement at least, means increased 

 expense. There must be separate and well-appointed laboratories for 

 chemical, physiological, anatomical, and pathological research, rooms 

 for photography, germ-culture, delicate electrical apparatus, for hygi- 

 enic and therapeutic demonstrations, for libraries, and for the recep- 

 tion and treatment of many classes of patients at clinics. Moreover, 

 assistant instructors and demonstrators are needed, in order that each 

 student may receive a fair share of personal attention. (At present 

 the classes are so large that candidates for graduation are often un- 

 known by sight even to a majority of their instructors.) 



Suppose for a moment that the professors of a medical college put 

 their hands in their own pockets and provide these improvements, as 

 they have already done in some instances to a limited extent. Many 

 students will leave for cheaper and easier colleges, and the fees are 

 likely to fall off so much that professorships having no endowments to 

 rely upon must be abandoned. Thus the lack of endowment is a vir- 

 tual check upon all growth. Division of labor with a new assistant 

 instructor means division of personal income with him. The expense 

 of maintaining a new laboratory means a further reduction of the pro- 

 fessor's income. As Dr. O. W. Holmes wittily says, " A school which 

 depends for its existence on the number of its students, can not be ex- 

 pected to commit suicide in order to satisfy an ideal demand for per- 

 fection."* General Eaton (to whose admirable report on medical 

 education f the writer is indebted for many of the statistics of this 

 article) strongly advises that every medical school or college be re- 

 quired by law to procure forthwith an endowment of not less than 

 $300,000. 



Strangely enough, in some instances the professors themselves ob- 

 ject to the endowment of their chairs, because they fear a sacrifice of 

 their independent methods, or because it seems impossible to secure 

 endowments which would yield as fair incomes as they at present 

 derive from the students' fees. But there is no reason why the stu- 

 dents should not continue to pay as they do now, and a certain 

 amount of endowment, required by law, would prevent half a dozen 

 men from forming a new medical college without proper laboratories, 

 apparatus, or facilities of any kind. The experience of the past ten 

 years proves this danger to be a real and increasing one. 



The professorships and laboratories once endowed, the professors 

 can be trusted to elevate the standard of medical education very rap- 

 idly throughout the country. But there should also be separate State 

 or National Boards of Examiners who alone should have the power 

 of granting licenses to practice medicine, based upon proofs of prac- 



* " Boston Medical and Surgical Journal," January 19, 1882. 

 f "Report of the Commissioner of Education," 1882-'83, clxiii-clxxxiv, 660-672. 

 vol. xxvn. 38 



