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Rh inaccessibility, the Ann Arbor type of school. As for the rest, the great northwestern territory will, as it develops, create whatever additional facilities it may require.

In so far as the United States is concerned, the foregoing sketch calls for 31 medical schools with a present annual output of about 2000 physicians, i. e., an average graduating class of about 70 each. They are capable of producing 3500. 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 institutions. Divided and far distant departments are altogether avoided.

Twenty states are left without a complete 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 undertaking feasible within a decade or two. The University of Arkansas might be moved from Fayetteville to Little Rock; Oklahoma, if its rapid growth is maintained, may from Norman govern a medical school at Oklahoma City; Oregon may take full responsibility for Portland. Unfortunately, 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 reconstruction, 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 disappear, 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 institutions without seriously stretching their present enrolment. Of the 30 institutions that remain, several will survive through merger. For example, the Cleveland College 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 Harvard, Vanderbilt and the University of Tennessee, Creighton and the University of Nebraska, would, if joined, form institutions of moderate size, capable of considerable expansion before reaching the limit of efficiency.

In order that these mergers may be effective, not only institutional, but personal ambition must be sacrificed. It is an advantage 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 Cincinnati, Indianapolis, Louisville, Nashville,