46 



SCIENCE 



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



inadequate: three of the six are still de- 

 pendent upon fees for both plant and main- 

 tenance. It is doubtful whether the other 

 universities of the south should generally 

 ofEer even the instruction of the first two 

 years. The scale upon which these two- 

 year departments can be now organized by 

 them is below the minimum of continuous 

 efficiency; they can contribute nothing to 

 science, and their quota of physicians can 

 be better trained in one of the six schools 

 suggested. Concentration in the interest 

 of effectiveness, team work between all in- 

 stitutions working in the cause of southern 

 development, economy as a means of im- 

 proving the lot of the teacher — these meas- 

 ures, advisable everywhere, are especially 

 urgent in the south. 



4. In the north central tier — Ohio, Indi- 

 ana, Michigan, Wisconsin, Illinois — popu- 

 lation increased 239,685 the last year: 160 

 doctors would care for the increase; 190 

 more would replace one half of those that 

 died: a total of 350. Large cities with 

 resident universities available for medical 

 education are Cincinnati, Columbus, Cleve- 

 land and Chicago. Ann Arbor has demon- 

 strated the ability successfully to combat 

 the disadvantages of a small town. The 

 University of Wisconsin can unquestion- 

 ably do the same, with a slighter handicap, 

 at Madison whenever it chooses to complete 

 its work there. Indiana University has 

 undertaken the problem of a distant con- 

 nection at Indianapolis. Four cities thus 

 fulfil all our criteria, two more develop the 

 small town type, one more is an experiment 

 with the remote university department. 

 Surely the territory in question can be sup- 

 plied by these seven medical centers. Chi- 

 cago alone is likely to draw a considerable 

 number of students from a wider area. It 

 has long been a populous medical center. 

 Nevertheless the number of high-grade stu- 

 dents it just now contains is not large. If 



the practise of medicine in this area rested 

 on a two-year college basis, as it well might, 

 there would to-day be perhaps 600 stu- 

 dents of medicine in that city. Coopera- 

 tive effort between the two universities 

 there and the state university at Urbana 

 would readily provide for them. 



5. The middle west comprises eight 

 states, Minnesota, Iowa, Missouri, Okla- 

 homa, Kansas, Nebraska, South Dakota, 

 North Dakota, with a gain in population 

 last year of 216,036, requiring 140 more 

 physicians, plus 160 to replace half the 

 deaths: a total of 300. To supply them, 

 urban universities capable of conducting 

 medical departments of proper type are 

 situated in Minneapolis and St. Louis ; and 

 both deserve strong, well supported schools. 

 For Minneapolis must largely carry the 

 weight of the Dakotas and Montana; St. 

 Louis must assist Texas and have an eye to 

 Arkansas, Oklahoma and the southwest. 

 The University of Nebraska, now disper- 

 sing its energies through a divided school, 

 can be added to this list; for it will quite 

 certainly either concentrate the department 

 on its own site (Lincoln, population 48,- 

 232), or bring the two pieces together at 

 Omaha, only an hour's distance away. 

 The University of Kansas will doubtless 

 combine its divided department at Kansas 

 City. The State University of Iowa emu- 

 lates Ann Arbor at Iowa City. These five 

 schools must produce 297 doctors annually. 

 Their capacity would go much farther. 

 Oklahoma* and the Dakotas might well for 

 a time postpone the entire question, sup- 

 porting the work of the first two years, 

 which they have already undertaken, on a 

 much more liberal basis than they have yet 

 reached. With the exception of St. Louis, 



^ Should it be possible for tlie State University 

 of Oklahoma, by engaging in clinical work at 

 Oklahoma City, to get and to retain a monopoly 

 of the field, the step would doubtless be advisable 

 even now. 



