used in providing teaching, the quality of instruction is still further impaired. As the country becomes able and willing to support at a loss the number of schools needed, the ethical justification of other schools that must pay a profit—even though that profit go into buildings and equipment—becomes decidedly dubious.
Most of the existing medical school plants have been provided in this manner; quite commonly those who have participated in the operation fail to reflect on its significance. For if a good medical education costs more than the student pays in fees, then, even though an adequate plant has been provided in advance, his instruction must at some essential points be curtailed if additional income is not available. If, however, fees must provide either initial plant or plant extension, it is clear that proper teaching must be still further refused during the years when fees are employed to accumulate equipment. Historically that is the explanation of our extensive medical school plants in New York, Philadelphia, Baltimore, Louisville, Chicago: instruction far below what was at the moment scientifically feasible was given to the current student body, in order that their fees might be used to provide a better basis for a body of students that would come along in the future. Didactic lectures were given in 1890, to pay for a building in which laboratory instruction could be given in 1900. As conditions improved, one laboratory was put into operation, while a fee surplus was accumulated to install a second. Before the day of medical school support by endowment or taxation, such procedure compared very favorably indeed with the more common practice of doing nothing for the student of to-day and as little as possible for the student of to-morrow. The point now to aim at is the development of the requisite number of properly supported institutions and the speedy demise of all others.
In varying degrees, contented acceptance of these conditions goes along with the survival, however insidiously, of the notion that medical education, whatever else it may be, is something of a business, too. It is questionable whether this notion can ever be uprooted, so long as several competing schools in the same or in adjacent towns solicit patronage that can never again be sufficient in volume to satisfy them all. The essence of a business transaction consists in spending less in producing an article than is paid for it over the counter, how much less depending now on the proximity and competitive eagerness of other dealers, now on the wariness and number of the customers. It matters not that in this instance the article is education, the counter the registrar's latticed window, the profit going in extreme cases in large sums into a doctor's pocket, in the best cases in smaller sums into bricks and microscopes. If, in other words, medical education is a social function, it is not a proper object for either institutional or individual exploitation. Society ought to provide means for its support according to the best light obtainable; and the law should make it impossible for any person or institution to engage in it on any other than the best terms that society is in position to enforce. Great departures from this principle were at one time inevitable: the country was bound to have doctors; it had to take them
