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ACTUAL BASIS OF MEDICAL EDUCATION
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students so ignorant and clumsy. Many of them, gotten through advertising, would make better farmers. There's no use in having apparatus for experimental physiology—the men could n't use it; they're all thumbs."

Statistical proof of inadequacy of preparation is furnished by what one may fairly call the abnormal mortality within schools operating on the basis of "equivalents." The standards of promotion in these schools watch narrowly the action of the state boards, which are usually lenient. The schools are too weak financially to do otherwise; doubtful points are resolved in the boy's favor.[1] Hence the school examinations play less havoc than would follow tests strictly constructed in the public interest. Yet the mortality from one cause or another by the close of the first year runs from 20 to 50 per cent. At the Medico-Chirurgical College of Philadelphia an initial first-year enrolment of 152 in October fell to 100[2] by the following January first; of these, 60 passed without conditions, much less than one-half the original class enrolment; at Tufts the entering class 1908–9 shows in the catalogue an enrolment of 141; 75 were promoted, with or without conditions, into the sophomore class;[3] at Cornell, on its former high school basis, the failures at the close of the first year in a period often years averaged 28 per cent; at Buffalo, the failed and conditioned of three successive first-year classes amounted to 40 per cent of the total enrolment; at Vanderbilt, out of a class of 70, the dropped, conditioned, and failed amounted to 44 per cent; at the College of Physicians and Surgeons, Atlanta, 70 per cent, out of a class of 99. In schools on the higher basis, i.e., two years of college work or better, the instruction is more elaborate, the work more difficult, and the examinations harder; for scientific ideals rather than chances with the state board dominate. Yet the mortality drops decisively. At the Johns Hopkins, the mortality during three successive years averages less than 5 per cent, only half of which is due to failure; at Ann Arbor, on the one-year college basis, the mortality is below 10 per cent. The exhibit made by institutions that have tried both standards is especially instructive. At the University of Missouri, during the last three years of the high school or equivalent basis, there was a mortality due to actual failure of 35 per cent; during the following three years, when one year of college work was required, the mortality fell to 12½ per cent. At the medical department of the University of Minnesota, during the last three years of the high school requirement, the mortality was

  1. The dean of one school admitted that he carried "men easily from class to class, but plucked them in the last year,"—an excellent thing for the school: it collects three years' fees and still avoids a low record in the state board examinations.
  2. Some dropped out because unable to qualify, a few for lack of funds, others because of inability to do the work; but the enormous number that drop or fail, throws a strong light on the miscellaneous character of the enrolment obtained on the "equivalent" basis.
  3. It is relatively immaterial to our argument what became of the other 66; they represent fatalities for most of which low standards are to blame. As a matter of fact they are thus accounted for: 14 were dropped students (not catalogued with their class on account of conditions); 20 failed of promotion; 17 took all or a portion of first-year examinations 1908–9, but did not return 1909–10; 15 left before the final examinations.