July S, 1910] 



SCIENCE 



41 



to a degree, expecting no magician to lift 

 him over hard work, and later to put him 

 down softly in easy engineering positions. 

 To all such the Throop Polytechnic Insti- 

 tute says, ' ' Come this way ! ' ' 



Heney S. Caehart 



MEDICAL EDUCATION IN THE UNITED 

 STATES AND CANADA^ 

 The necessity of a reconstruction that 

 will at once reduce the number and im- 

 prove the output of medical schools may 

 now be taken as demonstrated. A consid- 

 erable sloughing off has already occurred. 

 It would have gone further but for the 

 action of colleges and universities which 

 have by affiliation obstructed nature's own 

 effort at readjustment. Affiliation is now 

 in the air. Medical schools that have either 

 ceased to prosper, or that have become sen- 

 sitive to the imputation of proprietary 

 status or commercial motive, seek to secure 

 their future or to escape their past by con- 

 tracting an academic alliance. The pres- 

 ent chapter undertakes to work out a 

 schematic reconstruction which may sug- 

 gest a feasible course for the future. It is 

 not supposed that violent measures will at 

 once be taken to reconstitute the situation 

 on the basis here worked out. A solution 

 so entirely suggested by impersonal con- 

 siderations may indeed never be reached. 

 But legislators and educators alike may be 

 assisted by a theoretical solution to which, 

 as specific problems arise, they may refer. 



This solution deals only with the present 

 and the near future — a generation, at most. 

 In the course of the next thirty years needs 

 will develop of which we here take no ac- 

 count. As we can not foretell them, we 

 shall not endeavor to meet them. Certain 

 it is that they will be most effectively 

 handled if they crop up freely in an unen- 

 'From the Report to the Carnegie Foundation 

 for the Advancement of Teaching by Abraham 

 Flexner. 



cumbered field. It is therefore higlily un- 

 desirable that superfluous schools now ex- 

 isting should be perpetuated in order that 

 a subsequent generation may find a means 

 of producing its doctors provided in ad- 

 vance. The cost of prolonging life through 

 this intervening period will be worse than 

 wasted; and an adequate provision at that 

 moment will be embarrassed by inheritance 

 and tradition. Let the new foundations of 

 that distant epoch enjoy the advantage of 

 the Johns Hopkins, starting without handi- 

 cap at the level of the best knowledge of its 

 day. 



The principles upon which reconstruc- 

 tion would proceed have been established 

 in the course of this report: (1) a medical 

 school is properly a university depart- 

 ment; it is most favorably located in a 

 large city, where the problem of procuring 

 clinical material, at once abundant and 

 various, practically solves itself. Hence 

 those universities that have been located in 

 cities can most advantageously develop 

 medical schools. (2) Unfortunately, how- 

 ever, our universities have not always been 

 so placed. They began in many instances 

 as colleges or something less. Here a sup- 

 posed solicitude for youth suggested an 

 out-of-the-way location ; elsewhere political 

 bargaining brought about the same result. 

 The state universities of the south and 

 west, most likely to enjoy sufficient in- 

 comes, are often unfortunately located: 

 witness the University of Alabama at Tus- 

 caloosa, of Georgia at Athens, of Missis- 

 sippi at Oxford, of Missouri at Columbia, 

 of Arkansas at Fayetteville, of Kansas at 

 Lawrence, of South Dakota at Vermilion; 

 and that experience has taught us nothing 

 is proved by the recent location of the 

 State University of Oklahoma at Norman. 

 Some of these institutions are freed from 

 the necessity of undertaking to teach medi- 

 cine by an endowed institution better situ- 



