Page:Carnegie Flexner Report.djvu/164

146 Empire contains eighty-four cities whose population exceeds 50,000 each. Of its twenty-two medical schools, only eleven are to be found in them: that is, it possesses seventy-three gateways and centers without universities or medical schools. The remaining eleven schools are located in towns of less than 50,000 inhabitants, a university town of 30,000 being a fitter abode for medical study than a non-university town of half a million, in the judgment of those who have best succeeded with it.

That the existing system came about without reference to what the country needed or what was best for it may be easily demonstrated. Between 1904 and 1909 the country gained certainly upwards of 5,000,000 in population; during the same period the number of medical students actually decreased from 28,142 to 22,145, i.e., over 20 per cent. The average annual production of doctors from 1900 to 1909 was 5222; but last June the number dropped to 4442. Finally, the total number of medical colleges which reached its maximum—166 — in 1904 has in the five years since decreased about 10 per cent. Our problem is to calculate how far tendencies already observable may be carried without harm.

We have calculated that the south requires for the next generation 490 new doctors annually, the rest of the country, 1500. We must then provide machinery for the training of about 2000 graduates in medicine yearly. Reckoning fatalities of all kinds at ten per cent per annum, graduating classes of 2000 imply approximately junior classes of 2200, sophomore classes of 2440, freshman classes aggregating 2700,something over 9000 students of medicine. Thirty medical schools, with an average enrolment of 300 and average graduation classes of less than 70, will be easily equal to the task. As many of these could double both enrolment and output without danger, a provision planned to meet present needs is equally sufficient for our growth for years to come. It will be time to devise more schools when the productive limit of those now suggested shall come in sight.

For the purpose here in mind, the country may be conceived as divided into several sections, within each of which, with due regard to what it now contains, medical schools enough to satisfy its needs must be provided. Pending the fuller development of the states west of the Mississippi, the section east will have to relieve them of part of their responsibility. The provisional nature of our suggestions is thus obvious; for as the west increases in population, as its universities grow in number and strength, the balance will right itself; additional schools will be created in the west and south rather than in the north and east. It would of course be unfortunate to over-emphasize the importance of state lines. We shall do well to take advantage of every unmistakably favorable opportunity so long as we keep within the public need; and to encourage the freest possible circulation of students throughout the entire country.