private parties whose common interest it is to increase appropriations and to reduce oversight.[1] The size of the appropriation is determined to greater or less degree by the violence of the onset. There is no fixed relation between the charity work done and the amount asked or secured.[2] In pursuance of that policy the state of Pennsylvania last year granted out of the public treasury to private and semi-private hospitals $4,404,500.
However the hospital and dispensary are supported, the teaching budget of the clinical years is necessarily a charge upon the funds of the medical school. The professor of medicine in the medical school will be physician-in-chief to the hospital; surgeon, obstetrician, pediatrist, will likewise occupy the same dual relation. The university hospital will be their laboratory; their salaries will protect them against the distractions of successful practice, be that practice general or consultant,—for a thriving consultation business may prove just as fatal to scientific productivity as any other form of immersion in routine. The clinical departments must embody the same ideals as pathology or physiology in respect to teaching and research; they require, then, the same organization and support. The laboratory service must be extended for them. For the investigator in internal medicine needs not only a clinic, but a laboratory, in whose activities the bedside problem and the fundamental sciences are brought together. The professors of pathology, physiology, physiological chemistry, work on broad lines. The clinician applies what he obtains from them to problems that are narrower in compass. Neither the clinical laboratories, where routine examinations are carried on, nor the fundamental scientific laboratories, serve precisely the needs of the investigating clinician, though the latter are in the most intimate coöperation with him.
What may be called the theory of virtual endowment deserves a word at this point. Let us suppose that ten practitioners give their professorial services gratis. Undoubtedly their ethical position is better than that of practitioner teachers who draw dividends. They contend, however, that their services constitute an endowment. Paid teachers would get, say, $3000 each. The $30,000 saved represents five per cent on $600,000. It is argued that the school is just where it would be if it had an endowment of something more than a half-million. Sanguine calculators of this type occasionally run the virtual endowments up to two or three millions. But virtual endowment is a poor substitute for good bonds. The volunteer teacher may begin well; but as between teaching and practice, the former must always get the worst of it. Slipshod dispensaries, imperfect hospital records, general clinical barrenness, tell the tale.
- ↑ Experts are of one mind as to the viciousness of this policy. See, for example, Report on Subsidies, National Conference of Charities and Corrections, held at Washington, D.C., May 9-15, 1901.
- ↑ The amounts secured vary from 19 cents to $2 a day for free patients, according to the efficacy of the hospital "pull." In New York city "pull" is eliminated: the hospital is paid a fixed sum for service rendered. Nevertheless, even this method of procedure may have unfortunate educational consequences,—for it enabled the Brooklyn Post-Graduate Medical School to start.
