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xii If these fundamental principles can be made clear to the people of the United States and of Canada, and to those who govern the colleges and the universities, we may confidently expect that the next ten years will see a very much smaller number of medical schools in this country, but a greatly increased efficiency in medical education, and that during the same period medical education will become rightly articulated with, and rightly related to, the general educational system of the whole country.

In the suggestions which are made in this report looking toward the future development of medicine, it ought to be pointed out that no visionary or impossible achievement is contemplated. It is not expected that a Johns Hopkins Medical School can be erected immediately in cities where public support of education has hitherto been meager. Nevertheless, it is quite true that there is a certain minimum of equipment and a minimum of educational requirement without which no attempt ought to be made to teach medicine. Hitherto not only proprietary medical schools, but colleges and universities, have paid scant attention to this fact. They have been ready to assume the responsibility of turning loose upon a helpless community men licensed to the practice of medicine without any serious thought as to whether they had received a fair training or not. To-day, under the methods pursued in modern medicine, we know with certainty that a medical school cannot be conducted without a certain minimum of expense and without a certain minimum of facilities. The institution which attempts to conduct a school below this plane is clearly injuring, not helping, civilization. In the suggestions which are made in this report as to what constitutes a reasonable minimum no visionary ideal has been pursued, but only such things have been insisted upon as in the present light of our American civilization every community has a right to demand of its medical school, if medicine is to be taught at all.

It seems desirable also in connection with both the medical school and the university or college to add one word further concerning the relation of financial support to efficiency and sincerity. Where any criticism is attempted of inadequate methods or inadequate facilities, no reply is more common than this: "Our institution cannot be judged from its financial support. It depends upon the enthusiasm and the devotion of its teachers and its supporters, and such devotion cannot be measured by financial standards."

Such an answer contains so fine a sentiment and so pregnant a truth that it oftentimes serves to turn aside the most just criticism. It is true that every college must ultimately depend upon the spirit and devotion of those who work in it, but behind this noble statement hides most of the insincerity, sham, and pretense not only of the American medical school, but of the American college. The answer quoted is commonly made by the so-called university that, with an income insufficient to support a decent college, is trying to cover the whole field of university education. It is the same answer that one receives from the medical school which, with wholly inadequate facilities, is turning out upon an innocent and long-suffering community men