In view of this fact, the argument advanced for the retention of medical schools in places where good clinical instruction is impossible is directly against the public interest. If the argument were valid, it would mean that the sick man is better off in the hands of an incompetent home-grown practitioner than in those of one well trained in an outside school. Such an argument ought no longer to blind the eyes of intelligent men to the actual situation. Any state of the Union or any province of Canada is better off without a medical school than with one conducted in a commercial spirit and below a reasonable plane of efficiency. No state and no section of a state capable of supporting a good practitioner will suffer by following this policy. The state of Washington, which has no medical school within its borders, is doubtless supplied with as capable and well trained a body of medical practitioners as is Missouri with its eleven medical schools or Illinois with its fourteen.
The point of view which keeps in mind the needs and qualifications of the medical student and the interests of the great public is quite a different one from that which the institution which conducts a medical department ordinarily occupies. The questions which look largest to the institutions are: Can we add a medical school to our other departments? and if so, where can we find the students? The questions which the other point of view suggest are: Is a medical school needed? Cannot those qualified to study medicine find opportunities in existing schools? If not, are the means and the facilities at hand for teaching medicine on a right basis?
While the aim of the Foundation has throughout been constructive, its attitude towards the difficulties and problems of the situation is distinctly sympathetic. The report indeed turns the light upon conditions which, instead of being fruitful and inspiring, are in many instances commonplace, in other places bad, and in still others, scandalous. It is nevertheless true that no one set of men or no one school of medicine is responsible for what still remains in the form of commercial medical education. Our hope is that this report will make plain once for all that the day of the commercial medical school has passed. It will be observed that, except for a brief historical introduction, intended to show how present conditions have come about, no account is given of the past of any institution. The situation is described as it exists today in the hope that out of it, quite regardless of the past, a new order may be speedily developed. There is no need now of recriminations over what has been, or of apologies by way of defending a régime practically obsolete. Let us address ourselves resolutely to the task of reconstructing the American medical school on the lines of the highest modern ideals of efficiency and in accordance with the finest conceptions of public service.
It is hoped that both the purpose of the Foundation and its point of view as thus stated may be remembered in any consideration of the report which follows, and that this publication may serve as a starting-point both for the intelligent citizen and for the medical practitioner in a new national effort to strengthen the medical profession and rightly to relate medical education to the general system of schools of our nation.
