I(> 



SCIENCE. 



[Vol. XVIII. No. 440 



first class — thoroughly trained, authorities in their special 

 fields, capable of increasing knowledge, and with the pecul- 

 iar gift of ability to teach — do you suppose there are in this 

 country? It is a liberal estimate to say that a dozen of each 

 have thus far given evidence that they exist. And the great 

 clinical teachers in medicine and surgery, the men who are 

 up to the times in matters of diagnosis, pathology, and ther- 

 apeutics, and who are also successful teachers both by the 

 spoken and written word, — how many such have we, and 

 especially how many such have we who are not fixed and 

 established, so that they may be induced to go to a school 

 which needs them? Such men are either men of genius — 

 and even this boasted nineteenth centui'y has produced them 

 rarely — or they are men of talent made the most of by uii- 

 flagging industry with special opportunities, and these are 

 also rare. Yet these are the men whom a great university 

 should seek to obtain and retain for her faculties. To do 

 this, and to get the best work from such men, is by no means 

 a mere matter of salary, although sufficient salaries must be 

 paid. We have also to consider the buildings, collections, 

 books, and apparatus required, and this is largely a question 

 of money. How much money? What would be the cost of 

 establishing and maintaining a first-class medical school in 

 this country at the present time? Let us suppose that one 

 liundi-ed and fifty students are to be provided for, that the 

 course of instruction for those coming with a good high- 

 school education is to occupy four years, and for those com- 

 ing with the degree of bachelor of arts, aad having done at 

 least one year's work in a chemical laboratory and one year's 

 -\vork in a biological laboratory, the course shall occupy 

 three years; that the last year's studies shall be almost ex- 

 clusively clinical, and that provision is to be made for ad- 

 vanced post-graduate work. 



We shall want, then, practical anatomy rooms for fifty 

 students, a physiological laboratory, a pathological labora- 

 tory, a pharmacological laboratory, a laboratory of hygiene, 

 and the means of clinical teaching, a library, and a museum. 

 The days have long gone by when one or two amphitheatres 

 or lecture-rooms and a small museum were all the outfit re- 

 quired for medical teaching. The little amphitheatre of the 

 University of Bologna was sufficient for almost every pur- 

 pose of medical teaching as it was carried on three hundred 

 years ago, but now the lecture-room is the smallest part of 

 the outfit required. In his evidence before the Royal Com- 

 mission, Professor Lankester stated that to establish such a 

 medical school at Oxford as he thought desirable, about 

 $225,000 would be required for buildings, in addition to 

 those already existing, and that about $100,000 a year would 

 be required for running expenses. Professor Billroth esti- 

 mates that about $400,000 would be required for buildings 

 for the medical department of a university, exclusive of the 

 buildings for clinical teaching, which he thinks would cost 

 about as much more; and that the annual expense would be 

 about $105,000. He says that these estimates are based on an 

 average standard of efficiency, not the highest, and concludes 

 by saying; "Let us hope that a rich man may some day 

 give three millions of dollars to found a school to be devoted 

 to medicine and natural science." 



Perhaps these figures may seem high to you. Yet build- 

 ing is cheaper and salaries lower in England and in Ger- 

 many than with us, if only first-class work and first-class 

 men are accepted. To build and equip a laboratory which 

 shall give work-room for seventy-five men, will cost here 

 between $75,000 and $100,000. At least four such laborato- 

 ries are needed by the ideal medical department, besides a 



building for general lectures, library, etc. , which would cost 

 about $50,000. 



It is, of course, possible to consolidate all these into a sin- 

 gle three or four story building, and thus save money, espe- 

 cially in cost of ground, but the results are not so good. I 

 am not speaking now of temporary, makeshift buildings, but 

 of permanent structures, which though plain should not be 

 hideous, and should be thoroughly well built. Where land 

 is abundant and not too dear, it is usually better to construct 

 these laboratories one at a time, and endeavor to secure for 

 each a proper endowment and equipment. The average ex- 

 penses of each laboratory may be put at $15,000 per annum. 

 In other words, it requires about $400,000 to build, equip, 

 and endow a physiological, pathological, or hygienic labora- 

 tory such as is suited to the needs of a first-class university 

 in this country. By paring down in various directions, this 

 sum can be reduced to $300,000, but not lower without seri- 

 ously impairing the efficiency of the plan. And in all this 

 I have said nothing of the cost of the means for clinical in- 

 struction, which should be borne, in part at least, by the 

 school, for the simple reason that only by doing this can the 

 school have that control of hospital appointments which is 

 so necessary for its proper work. 



Of course every professor who is skilled and energetic, and 

 who is imbued with the true university spirit, has innumer- 

 able wants and suggestions which i-equire money to supply 

 and carry out. He wants the new books and journals re- 

 lating to his specialty, specimens, apparatus, models, and 

 illustrations; and if he is at the head of one of the laborato- 

 ries which I have named, the sum of $15,000 per annum will 

 be required to pay him and his assistants, and to provide for 

 their needs. All this means that the educating of physicians 

 on this plan will cost the medical department between four 

 and five thousand dollars for each graduate. It will receive 

 from them eight hundred to one thousand dollars each, and 

 the balance must be made up from subscriptions, appropria- 

 tions, or endowments. Practically, endowment is the only 

 resource. 



The student himself has to give four or five years' time 

 and labor, and four or five thousand dollars, to obtain his 

 medical education. For some, this expenditure of time and 

 money will be an excellent investment; for others, not, — 

 even if they have enough of both to spare for this purpose. 

 After all, the most that the university can do is to afford 

 opportunities for learning, and a certain kind and amount 

 of stimulus to mental work. The professor may declare that 

 he will teach certain branches; but there are some sent to 

 him for instruction who are not teachable, and the only 

 thing he can do is to return them as little damaged as possi- 

 ble. 



The number of men for whom it is specially desirable to 

 provide laboratory and other special facilities for original 

 work in physiology, pathology, pharmacology, and hygiene 

 is limited. There are not a great number of men who have 

 the desire and qualifications necessary for this sort of work, 

 and the number of positions in which they can find remu- 

 nerative employment in devoting themselves to such inves- 

 tigations is still more limited. 



The laboratory facilities in Germany are, as a whole, at 

 present in excess of the number of properly qualified men 

 who can be found to make use of them, although a few are 

 overcrowded. 



Advanced work and original investigations cannot, as a 

 rule, be made by undergraduates, if for no other reason than 

 that of lack of time. 



