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6 This organic connection guaranteed certain standards and ideals, modest enough at that time, but destined to a development which medical education could, as experience proved, ill afford to forego. Even had the university relation been preserved, the precise requirements of the Philadelphia College would not indeed have been permanently tenable. The rapid expansion of the country, with the inevitable decay of the apprentice system in consequence, must necessarily have lowered the terms of entrance upon the study. But for a time only: the requirements of medical education would then have slowly risen with the general increase in our educational resources. Medical education would have been part of the entire movement instead of an exception to it. The number of schools would have been well within the number of actual universities, in whose development as respects endowments, laboratories, and libraries they would have partaken; and the country would have been spared the demoralizing experience in medical education from which it is but now painfully awakening.

Quite aside from the history, achievements, or present merits of any particular independent medical school, the creation of the type was the fertile source of unforeseen harm to medical education and to medical practice. Since that day medical colleges have multiplied without restraint, now by fission, now by sheer spontaneous generation. Between 1810 and 1840, twenty-six new medical schools sprang up; between 1840 and 1876, forty-seven more; and the number actually surviving in 1876 has been since then much more than doubled. First and last, the United States and Canada have in little more than a century produced four hundred and fifty-seven medical schools, many, of course, short-lived, and perhaps fifty still-born. One hundred and fifty-five survive to-day. Of these, Illinois, prolific mother of thirty-nine medical colleges, still harbors in the city of Chicago fourteen; forty-two sprang from the fertile soil of Missouri, twelve of them still "going" concerns; the Empire State produced forty-three, with eleven survivors; Indiana, twenty-seven, with two survivors; Pennsylvania, twenty, with eight survivors; Tennessee, eighteen, with nine survivors. The city of Cincinnati brought forth about twenty, the city of Louisville eleven. These enterprises—for the most part they can be called schools or institutions only by courtesy—were frequently set up regardless of opportunity or need: in small towns as readily as in large, and at times almost in the heart of the wilderness. No field, however limited, was ever effectually preëmpted. Wherever and whenever the roster of untitled practitioners rose above half a dozen, a medical school was likely at any moment to be precipitated. Nothing was really essential but