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144 recent location of the State University of Oklahoma at Norman. Some of these institutions are freed from the necessity of undertaking to teach medicine by an endowed institution better situated; 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 reputation; 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 faculty of medicine in these schools may even turn the defect of situation to good account; for, freed from distraction, the medical 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 university 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-distance connection is justified only where there is no local university qualified to assume responsibility. A third solution—division—may, if the position taken in previous chapters is sound, be disregarded in the final disposition.

(3) We shall assign only one school to a single town. As a matter of fact, no American city now contains more than one well 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 undoubtedly move the first to spend several hundred 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 elevation: witness the attitude of several institutions 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 throughout 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