(3) Greater unevenness must be tolerated in the south;[1] proprietary schools or nominal university departments will doubtless survive longer there than in other parts of the country because of the financial weakness of both endowed and tax-supported institutions. All the more important, therefore, for universities to deal with the subject in a large spirit, avoiding both overlapping and duplication. An institution may well be glad to be absolved from responsibilities that some other is better fitted to meet. Tulane and Vanderbilt, for example, are excellently situated in respect to medical education; the former has already a considerable endowment applicable to medicine. The state universities of Louisiana and Tennessee may therefore resign medicine to these endowed institutions, grateful for the opportunity to cultivate other fields. Every added superfluous school weakens the whole by wasting money and scattering the eligible student body. None of the southern state universities, indeed, is wisely placed: Texas has no alternative but a remote department, such as it now supports at Galveston; Georgia will one day develop a university medical school at Atlanta; Alabama, at Birmingham,—the university being close by, at Tuscaloosa. The University of Virginia is repeating Ann Arbor at Charlottesville; whether it would do better to operate a remote department at Richmond or Norfolk, the future will determine. Six schools are thus provided:[2] they are sufficient to the needs of the section just now. The resources available even for their support are as yet painfully inadequate: three of the six are still dependent upon fees for both plant and maintenance. It is doubtful whether the other universities of the south should generally offer even the instruction of the first two years. The scale upon which these two-year departments can be now organized by them is below the minimum of continuous efficiency; they can contribute nothing to science, and their quota of physicians can be better trained in one of the six schools suggested. Concentration in the interest of effectiveness, team work between all institutions working in the cause of southern development, economy as a means of improving the lot of the teacher—these measures, advisable everywhere, are especially urgent in the south.
(4) In the north central tier—Ohio, Indiana, Michigan, Wisconsin, Illinois—population increased 239,685 the last year: 160 doctors would care for the increase; 190 more would replace one-half of those that died: a total of 350. Large cities with resident universities available for medical education are Cincinnati, Columbus, Cleveland, and Chicago. Ann Arbor has demonstrated the ability successfully to combat the disadvantages of a small town. The University of Wisconsin can unquestionably do the same, with a slighter handicap, at Madison whenever it chooses to complete its work there. Indiana University has undertaken the problem of a distant connection at Indianapolis. Four cities thus fulfil all our criteria, two more develop the small town type, one more is an experiment with the remote university department.
