FINANCIAL AID TO MEDICAL COLLEGES.

Aside from the usual incomes for maintenance, incomplete returns show the gifts during the year for endowments, new buildings, research, and public-health instruction in medical schools amounted to over $9,000,000. Among these gifts were: One of $4,000,000 to Cornell University Medical College, by an anonymous donor; $1,500,000 from the General Education Board to the Johns Hopkins University Medical Department, to provide for the employment of all-time professors in three main clinical branches; a gift of $750,000 for Washington University Medical School, St. Louis; and another of $500,000 to the Yale Medical School from the General Education Board to provide for all-time clinical professors. Because of litigation the gift of $1,000,000 made by Mr. Carnegie to Vanderbilt University Medical Department about two years ago was not available for use until this year. Numerous personal gifts were made to different medical schools, ranging from $5,000 to $250,000. For medical research at the Rockefeller Institute-not connected with any medical college-Mr. Rockefeller gave an additional $3,500,000 to establish a department of animal pathology. Sums amounting to at least $4,010,750 were given during the year to build and maintain teaching hospitals. So far as reports were received, nearly $17,000,000 in all was given during the past 12 or 14 months for medical education, teaching hospitals, and medical research.

CLOSER RELATIONS WITH HOSPITALS.

It has now come to be clearly recognized that among the best conducted hospitals in the country are those which are the teaching hospitals of high-grade medical schools. The atmosphere of study and research in the medical school seems also to permeate the hospital. The attending physicians of the staff, who are also on the faculty of the medical school, are more apt to be acquainted with the latest improved methods of diagnosis and treatment, and the patients naturally get the benefit of this knowledge. It is not surprising, therefore, that during the past year many hospitals have sought closer relationships with medical schools or have become teaching hospitals. Others have given medical schools wider privileges in their wards. During the year notable new buildings have been completed at St. Louis for the Barnes and St. Louis Children's Hospitals, on grounds adjoining the new campus of the Washington University Medical School; at Boston, the large new buildings of the Peter Bent Brigham Hospital have been completed on property near the Medical School of Harvard University; at Cincinnati, some of the beautiful new buildings of the Cincinnati City Hospital have been completed-this being the teaching hospital of the Medical College

of the University of Cincinnati; at Indianapolis, the new Robert W. Long State Hospital has been completed, this being the teaching hospital of the Indiana University School of Medicine; at Nashville, Tenn., the new Galloway Memorial Hospital, the teaching hospital of the Vanderbilt University Medical Department, is rapidly approaching completion; at Chicago, Wesley Hospital, the teaching hospital of the Northwestern University Medical School received $1,000,000 as an endowment fund for charity beds; at Cleveland, larger teaching privileges in the City Hospital have been granted to Western Reserve University Medical School; at San Francisco a new teaching hospital is to be erected for the University of California College of Medicine.

DEVELOPMENT BY LIMITATION.

Development by limitation is possible in medical education, even as a pruning of fruit trees leads to the production of better fruit. A year or two ago the Johns Hopkins University Medical Department adopted a rule limiting the enrollment of students in each class to 90, believing that with its present laboratories and equipment the best instruction could not be given to larger numbers. This year Rush Medical College, affiliated with the University of Chicago, has announced that only 100 students each will be accepted in the first and second year classes and 120 each in the third and fourth year classes.

In past years several medical colleges-notably the medical departments of the State Universities of Mississippi, Missouri, and North Carolina-voluntarily discontinued teaching the clinical years of the medical course, owing to the fact that the small cities in which they were located did not furnish an adequate amount of clinical material. During the last year another medical school, that of Dartmouth College, the fourth oldest medical college in the United States, with a record of granting degrees in medicine for 103 consecutive years, has voluntarily discontinued teaching the clinical years, because sufficient clinical material was not available at HanThe action in this last instance can not have been taken without a feeling of great regret and yet was promptly voted when the real conditions were understood. It is another example of the noteworthy decisions that, in the last several years, have marked the campaign for better-trained physicians in this country. Meanwhile, this elimination at the Dartmouth Medical School opens the way for a marked development of the teaching of the first two years of the medical course.

over.

HELPS IN THE GENERAL PROGRESS.

The rapid improvements thus far brought about in medical education are largely due to the voluntary action on the part of the better medical colleges following reports that have set forth the actual conditions existing in this country as compared with medical education in the other leading countries of the world. Mergers of two or more colleges in each of numerous cities were promptly made in order to form in each instance one stronger and better medical college. Higher entrance requirements were announced, campaigns for endowments were instigated, and the general upward movement began. There remained, however, a considerable number of medical colleges with more or less commercial aims from which voluntary development was hardly to be expected. Many of these were forced to elevate their standards or to close their doors through the action of the State medical licensing boards-the only bodies having the legal power to regulate medical colleges. Since the publication of the third classification of medical colleges 1 by the Council on Medical Education, it has been ascertained that, as a rule, the degrees granted by these low-grade medical colleges are not accepted as a qualification for license to practice in 31 States. These States are as follows: TABLE 5.-State boards not recognizing low-grade colleges.

Alabama.

Arkansas.

1

Colorado.

Minnesota.

The action of State licensing boards, therefore, is having a very salutary effect in fixing and enforcing reasonably high standards of preliminary and medical education. As may be noted in chart 3, page 200, however, many of the colleges had themselves voluntarily anticipated the higher standards and made radical improve

ments.

Meanwhile, unless the remaining 18 States secure the necessary laws giving their licensing boards power to refuse recognition to low-grade colleges, or unless the licensing boards make use of such

1 The latest revision of this classification is published in Jour, of Amer. Med. Assoc., Aug. 22, 1914, p. 669. A reprint containing this classification will be sent to any address on request.

2 A table showing in what States certain medical colleges are not given unqualified recognition may be found in Jour. of Amer. Med. Assoc. of May 23, 1914, p. 1650.

powers as are conferred on them, those States will be in danger of becoming the dumping ground for the product of these low-standard colleges.

OTHER IMPROVEMENTS BY LICENSING BOARDS.

Since a year ago 4 more licensing boards have been empowered to establish standards of preliminary education. Three more States— Arkansas, Georgia, and Louisiana-have fixed the preliminary requirement at a four-year high-school education; 12 more boards have adopted (see Table 4) the requirement of one or two years of collegiate work in addition to a four-year high-school education; 4 more State boards and that of Porto Rico (see Table 5) have adopted a rule refusing to recognize low-standard medical colleges; and 1 more State, Georgia, has secured a practice act establishing a single medical examiner, to replace three independent and conflicting boards.

The progress of the last year and of the last 10 years is shown in Table 6.

TABLE 6.-Advances in State license requirements in ten years.

There are still 5 States in which the medical-practice acts make no provision for standards of preliminary education, these being the District of Columbia, Florida, Massachusetts, Oregon, and Tennessee. The 9 States in which no standard has been fixed or in which the requirement of preliminary education is evidently less than a fouryear high-school education are:

The 4 States which still allow nongraduates in medicine-those whose training is thus known to be incomplets-to take the examination for license, are Colorado, Massachusetts, Oregon, and Tennessee.

Because of the severity of the examination such candidates are seldom able to secure licenses in Colorado and Oregon, and only a few succeed in getting over the minimum percentage required in Massachusetts. In Tennessee, on the contrary, statistics show that, of the 1,187 candidates licensed by examination in the last four years, 515, or 43.4 per cent, were nongraduates. A strong effort is to be made to secure a new practice act in Tennessee, however.

The 12 States in which the licensing boards do not appear to have full authority to withdraw recognition from low-grade medical colleges are:

In the following States the laws apparently give the boards authority to refuse recognition to low-grade colleges, but, so far as has been reported, the boards are as yet making little use of that authority:

There are yet 9 States in which the licensing boards have not established the so-called “reciprocal relations" with other States, by which the license issued to a physician by one State is recognized without further examination by the other, in case the physician desires for good reasons to move to the latter State. These States are:

3

Oregon.
Rhode Island.
Washington.

Under the present control of licensure, a physician who is licensed in one State and who for good reasons desires to move to another State has to submit to a second tedious examination, including oftentimes very impractical questions. To offset this difficulty reciprocal relations have, in recent years, been established between States of supposedly equal standards, whereby one board will accept the examination of the other as equal to its own, on condition that the other board will reciprocate. Such relations have been established by the majority of States, but in many instances with only 1 to 10 other

1 Authority divided between two or three separate and independent boards.

2 One medical college has been reported as "not in good standing."

3 One instance is reported of an eminent physician of national reputation who, when moving to another State, was required to undergo a written test of his ability to remember textbook words-the test being given, it was inferred, by one of his former pupils.