42 



SCIENCE 



[N. S. Vol. XXXII. No. 810 



ated ; in other sections the only universities 

 fitted by their large support and their 

 assured scientific ideals to maintain schools 

 of medicine are handicapped by inferiority 

 of location. We are not thereby justified 

 in surrendering the university principle. 

 Experience, our own or that of Germany, 

 proves, as we have already pointed out, 

 that the difficulty is not insuperable. At 

 relatively greater expense, it is still feasible 

 to develop a medical school in such an 

 environment : there is no magnet like repu- 

 tation ; nothing travels faster than the fame 

 of a great healer; distance is an obstacle 

 readily overcome by those who seek health. 

 The poor as well as the rich find their way 

 to shrines and healing springs. The fac- 

 ulty of medicine in these schools may even 

 turn the defect of situation to good ac- 

 count ; for, freed from distraction, the med- 

 ical schools at Iowa City and Ann Arbor 

 may the more readily cultivate clinical 

 science. An alternative may indeed be 

 tried in the shape of a remote department. 

 The problem in that case is to make univer- 

 sity control real, to impregnate the distant 

 school with genuine university spirit. The 

 difficulty of the task may well deter those 

 whose resources are scanty or who are 

 under no necessity of engaging in medical 

 teaching. As we need many universities 

 and but few medical schools, a long-dis- 

 tance connection is justified only where 

 there is no local university qualified to as- 

 sume responsibility. A third solution — • 

 division — may, if the position taken in pre- 

 vious chapters is soimd, be disregarded in 

 the final disposition. - 



(3) We shall assign only one school to a 

 single town. As a matter of fact, no Amer- 

 ican city now contains more than one well- 



'We shall omit the half-school because it may 

 be considered to divide with the whole school the 

 worlc of tlie first two years; it does not greatly 

 affect the clinical output, with which this chapter 

 is mainly concerned. 



supported university^ — and if we find it 

 unnecessary or impolitic to duplicate local 

 university plants, it is still less necessary to 

 duplicate medical schools. The needless 

 expense, the inevitable shrinkage of the 

 student body, the difficulty of recruiting 

 more than one faculty, the disturbance due 

 to competition for hospital services, argue 

 against local duplication. It is sometimes 

 contended that competition is stimulating: 

 Tufts claims to have waked up Harvard; 

 the second Little Rock school did undoubt- 

 edly move the first to spend several hun- 

 dred dollars on desks and apparatus. But 

 competition may also be demoralizing; the 

 necessity of finding students constitutes 

 medical schools which ought to elevate 

 standards the main obstacles to their ele- 

 vation : witness the attitude of several insti- 

 tutions in Boston, New York, Philadelphia, 

 Baltimore and Chicago. Moreover, local 

 competition is a stimulus far inferior to the 

 general scientific competition to which all 

 well equipped, well conducted and rightly 

 inspired university departments through- 

 out the civilized world are parties. The 

 English have experimented with both forms 

 — a single school in the large provincial 

 towns, a dozen or more in London — and 

 their experience inclines them to reduce as 

 far as possible the number of the London 

 schools. Amalgamation has already taken 

 place in certain American towns: the 

 several schools of Cincinnati, of Indianapo- 

 lis and of Louisville have all recently 

 "merged." This step is easy enough in 

 towns where there is either no university 

 or only one university. Where there are 

 several, as in Chicago, Boston and New 

 York, the problem is more difficult. Ap- 

 proached in a broad spirit it may, how- 

 ever, prove not insoluble; cooperation may 

 be arranged where several institutions all 



° Chicago is almost an exception, as Northwest- 

 ern University is situated at Evanston, a suburb. 



