the average size and capacity has been increased. In 1904, the averAlthough the number of medical colleges has been largely reduced, There was, therefore, one college for each one-half million people. 2 of and UNITED STATES EL E ཐ ΕΠ PO 19/201 19/30 FIG. 1.-Medical colleges and population, 1800-1925.-Medical graduates shown since 1880. Note that the number of medical colleges increased rapidly until 1900-much more rapidly than the population-and that since 1880 the numbers of graduates kept pace with the colleges. After 1904 both colleges and graduates were diminished until after 1922, when the numbers of graduates again increased, although the number of colleges still gradually decreased. Medical schools now have larger plants, and on the average a larger capacity. The number of graduates each year to satisfy the increases in population is approximately 4,000. the average number of graduates 50. ates was 36; now the average attendance in each college is 227 and age attendance per college was 176 and the average number of gradu 18 عد Although the number of medical colleges has been reduced, the average size and capacity has been increased. The largest number of medical schools was 162 in 1906; the largest numbers of students and graduates were in 1904 (figures in italics). The lowest number of medical colleges since 1871 was 79 in 1924; the lowest number of students was in 1919 and of medical graduates in 1922. INADEQUATE GOVERNMENTAL CONTROL OVER MEDICAL EDUCATION In this country the control of medical education and practice was left by the National Constitution to the police powers of the various States, a function which, if assumed at all by the States, was only to a limited and inadequate extent. In only a few States have efficient regulations been established over the chartering of educational institutions; and therefore no legal regulations were made in regard to essential buildings, finances, teachers, or equipment which a medical school should possess; and as a consequence the majority of medical schools established were of an inferior type. TABLE 2. The past century and medical education [Showing for certain years the numbers of medical colleges, students, and graduates in proportion to population] In the absence of adequate legal control, the agency best qualified to recognize the serious deficiencies in medical education was the medical profession, and at different times prior to 1900 investigations and reports in regard to these conditions were made by special com mittees of the American Medical Association. These had little effect other than to aid in stimulating a few States to create licensing boards and to begin some regulation of medical schools. The most effective work of this kind was that of the Illinois State Board of Health, during the secretaryship of John H. Rauch, as described in a previous report.1 For 15 years that board exerted the only powerful and nation-wide influence toward improvement in medical schools and in the closing of a score or more of notorious diploma mills in various parts of the country. In 1892 a change of administration in Illinois brought with it a sweeping change in the personnel of that board, including its able secretary, only one member of the former board remaining. Not only the forces for improvement but also the restrictions against institutions of low grade and of doubtful character were at once removed, and the country relapsed into another period in which low-grade medical schools were unhindered in their activity. LEGAL POWER V. PUBLICITY Beginning in 1900 the statistics collected and published in the Journal of the American Medical Association started a campaign for improvement, and in 1904 the association created a permanent council to exert continuous and persistent efforts toward that end. The work of this council, with its series of annual conferences, inspections and classifications of medical schools, the securing of mergers of two or more medical schools in each of many cities, and the recommending of higher entrance standards-all of this is now history. In 1910 the entry of the Carnegie Foundation for the Advancement of Teaching into the campaign not only obtained additional publicity to the campaign but also attracted the attention of philanthropists to the financial needs of medical education. The details of this campaign are given in greater detail in previous reports. By 1910 the number of medical schools had been reduced, mostly through mergers, from 160 to 95, the number of students from 28,142 to 12,930, and the number of graduates from 5,747 to 2,656. By 1924 the number of medical colleges was further reduced to 80, but the number of students had again increased to 17,728 and the number of graduates to 3,562. As a result of the improvements, however, 74 of the medical schools were in every way greatly improved institutions, and, of the students, 98 per cent were enrolled in these higher institutions, which also turned out 97 per cent of those who were graduated each year. In brief, the colleges had been reduced to half the former number, but the numbers of well-trained and qualified students and graduates had been tremendously increased. 1 Report of 1913, vol. 1, p. 32. It is interesting to note, also, that the number of students enrolled since the lowest ebb in 1919 has been increased by an average of 1,000 per year, nearly all of which have been trained in medical schools which in every way have been greatly improved. TABLE 3.-Entrance standards of medical schools GREATLY ENLARGED TEACHING PLANTS A marvelous development in the construction of large medical teaching plants has occurred during the past 15 years. Beginning with the large teaching plants for Johns Hopkins and Harvard, the wave of construction moved rapidly forward through both State and private medical schools until, in 1920, large teaching plants had been constructed in a score or more of medical schools. Among these are the medical schools of the State Universities of California, Georgia, Indiana, Iowa, Michigan, Minnesota, Nebraska, and Virginia; and among the private institutions were Chicago, Cincinnati, Jefferson, Pennsylvania, Rush, Stanford, Washington, and Yale. New but individual buildings were erected in about a score of others. More recently, greatly enlarged teaching plants have been constructed by the Universities of Colorado, Illinois, Ohio, Rochester (N. Y.), St. Louis, Vanderbilt, Western Reserve, and Wisconsin; and others are now in course of construction, or have been planned for early completion, at Chicago, Columbia, Iowa, and Northwestern Universities. The marvelous wave of improvements in the standards of medical education, therefore, has been followed by an equally marvelous period of construction of new and larger teaching plants. HOSPITALS AS RELATED TO MEDICAL EDUCATION Along with better buildings, better finances, improved laboratories, and more expert teachers, came also the necessity for closer relationships with hospitals, whereby the students under the supervision of other physicians could secure valuable experience by observing the examination and treatment of the sick in hospitals and mately 2,500 hospitals in the United States, whereas in 1924 the numbers have been greatly increased. In 1912 there were approxihave hospital connections. During the last 25 years, however, the medical schools increased, few of them were fortunate enough to of course, comparatively few hospitals; and, as the number of dispensaries. At the beginning of the nineteenth century there were, TOTAL NO. OF GRADS. 5,747 5,600 8 5.364 4980 4741 451 5 4440 4273 4,483 3.981 3.594 3.536 3,518 3,379 2.670 2,656 3,074 3.192 2,529 N3.120 3,250 3.700* 4500* 4.750* 1904 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 INCREASING NUMBERS OF QUALIFIED GRADUATES 415 8 832 1,017 = 1,041 917 859 1,167 1,336 1,665 2,398 2,499 2,867 N 2,929 2,347 N 2,964 N 3.050 N 3,650* N 4,400* N 4.600* FIG. 2.-Well-qualified physicians increasing, even with the reduced number of medical schools. The heavy line shows the total numbers of graduates in the respective years. The light line from the upper left corner of the chart shows the the examination and care of the sick. with a valuable training in the observation of, and assistance in, lationship with one or more hospitals and is providing its students schools, so that now every reputable medical school has a close rebetter relations have been established between hospitals and medical number had increased to over 7,000. As the numbers have increased, |