48 



SCIENCE 



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



Western (London) and Laval at Montreal 

 have no present function. At some future 

 time doubtless Dalhousie "University at 

 Halifax will need to create a medical de- 

 partment. The future of Queen's depends 

 on its ability to develop halfway between 

 Toronto and Montreal, despite comparative 

 inaccessibility, the Ann Arbor type of 

 school. As for the rest, the great north- 

 western territory will, as it develops, cre- 

 ate whatever additional facilities it may 

 require. 



In so far as the United States is con- 

 cerned, the foregoing sketch calls for 31 

 medical schools with a present annual out- 

 put of about 2,000 physicians, i. e., an aver- 

 age graduating class of about 70 each. They 

 are capable of producing 3,500. All are 

 university departments, busy in advancing 

 knowledge as well as in training doctors. 

 Nineteen are situated in large cities with 

 the universities of which they are organic 

 parts; four are in small towns with their 

 universities; eight are located in large 

 towns always close by the parent institu- 

 tions. Divided and far distant depart- 

 ments are altogether avoided. 



Twenty states'* are left without a com- 

 plete school. Most of these are unlikely to 

 be favorably circumstanced for the next 

 half century, so far as we can now judge. 

 Several may, however, find the underta- 

 king feasible within a decade or two. The 

 University of Arkansas might be moved 

 from Fayetteville to Little Rock; Okla- 

 homa, if its rapid growth is maintained, 

 may from Norman govern a medical school 

 at Oklahoma City; Oregon may take full 

 responsibility for Portland. Unfortu- 



° They are Maine, New Hampshire, Vermont, 

 West Virginia, North Carolina, South Carolina, 

 Florida, Mississippi, Kentucky, Arkansas, Okla- 

 homa, North Dakota, South Dakota, Montana, 

 Wyoming, Idaho, New Mexico, Arizona, Nevada, 

 Oregon. One school will not long content the 

 state of Texas. 



nately, of the three additional schools thus 

 created, only one, that at Little Rock, 

 would represent conditions at their best. 

 There is therefore no reason to hasten the 

 others ; for their problem may, if left open, 

 be more advantageously solved. 



To bring about the proposed reconstruc- 

 tion, some 120 schools have been apparently 

 wiped off the map. As a matter of fact, 

 our procedure is far less radical than would 

 thus appear. Of the 120 schools that dis- 

 appear, 37 are already negligible, for they 

 contain less than 50 students apiece; 13 

 more contain between 50 and 75 students 

 each, and 16 more between 75 and 100. 

 That is, of the 120 schools, 66 are so small 

 that their student bodies can, in so far as 

 they are worthy, be swept into strong insti- 

 tutions without seriously stretching their 

 present enrolment. Of the 30 institutions 

 that remain, several will survive through 

 merger. For example, the Cleveland Col- 

 lege of Physicians and Surgeons could be 

 consolidated with Western Reserve; the 

 amalgamation of Jefferson Medical College 

 and the University of Pennsylvania would 

 make one fair-sized school on an enforced 

 two-year college standard; Tufts and Har- 

 vard, Vanderbilt and the University of 

 Tennessee, Creighton and the University of 

 Nebraska, would, if .joined, form institu- 

 tions of moderate size, capable of consider- 

 able expansion before reaching the limit of 

 efficiency. 



In order that these mergers may be effec- 

 tive, not only institutional, but personal 

 ambition must be sacrificed. It is an ad- 

 vantage when two schools come together,- 

 but the advantage is gravely qualified if the 

 new faculty is the arithmetical sum of 

 both former faculties. The mergers at Cin- 

 cinnati, Indianapolis, Louisville, Nashville, 

 have been arranged in this way. The 

 fundamental principles of faculty organi- 

 zation are thus sacrificed. Unless combina- 



