Of our 155 medical schools, 120-odd depend on fees alone. Of these, there are better and worse: the former using the fees as far as they go to provide either several laboratory branches decently, or two or three well; the latter devoting but a part, often a small part, of the fee income to pedagogical use, distributing the rest among the teachers, who are in such cases always practising physicians.
The ethics of the case are clear. Let us grant that in the hope of ultimately getting to a sounder basis, it may have been justifiable for the more prosperous feesupported schools, whose total income is large enough to do something, to fight for survival. Surely they were, and are, morally bound meanwhile to furnish the best medical teaching procurable with such income as they enjoy. Their practitioner teachers were all the time profiting indirectly by their school connection; and this would suffice, if their motives were really as altruistic as is commonly alleged. Meanwhile, laboratories can be kept decent and laboratory teaching can as a rule be thorough only if full-time instructors are employed. These teachers have no income but their salaries. The medical school must therefore devote its fees primarily to paying them and to giving them the necessary facilities. Though the fee-supported school do this unreservedly, it will none the less omit part of its duty, because fees cannot support a complete set of laboratories efficiently organized. The school is therefore not justified in cutting out one or more of its possible laboratories in order to pay its clinical teachers. It must not only use its fees to pay for the right kind of laboratory instruction, but it must organize as many such laboratories as fees will support before paying anything to the clinical teachers, who profit indirectly nevertheless. A school may not be justified in existing even on this basis; that is, if the demand for doctors can be met by institutions that can do better for their students, there is no need to put up with even so altruistic a compromise. Surely an institution that is not willing to do so much as this has absolutely no defense unless a section is so hard run for doctors that it must take them on any terms upon which they can be procured. Such is not the case at this writing in any part of the United States or Canada. The younger men utilized in the dispensary ought probably to be treated on the same basis. For the dispensary is usually turned over to young men still struggling for a livelihood. A small annual stipend would go far to get from them the best service they are capable of rendering. To these two purposes the fee-supported school is in conscience bound to apply its income. As far as fees reach, orderly, even though modest, scientific departments and a well conducted dispensary service should be provided and paid for.
A few schools have squarely met their responsibility in this matter, and with results that prove them deserving of additional support. The medical department of Syracuse University has a total fee income of $28,861, which is spent on the scientific branches; the plant is not elaborate, but it is effective, attractive, and conscientiously managed. Within less than a year, the medical department of the University of Pittsburgh has come under complete university control. Prior to that
