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necessity of a reconstruction that will at once reduce the number and improve the output of medical schools may now be taken as demonstrated. A considerable 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 sensitive to the imputation of proprietary status or commercial motive, seek to secure their future or to escape their past by contracting an academic alliance. The present chapter undertakes to work out a schematic reconstruction which may suggest 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 considerations 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 account. As we cannot 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 unencumbered field. It is therefore highly undesirable that superfluous schools now existing should be perpetuated in order that a subsequent generation may find a means of producing its doctors provided in advance. 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 handicap at the level of the best knowledge of its day.

The principles upon which reconstruction would proceed have been established in the course of this report: (1) a medical school is properly a university department; 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, however, our universities have not always been so placed. They began in many instances as colleges or something less. Here a supposed 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 incomes, are often unfortunately located: witness the University of Alabama at Tuscaloosa, of Georgia at Athens, of Mississippi 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